Internal jugular vein phlebectasia: A systematic review of therapeutic approaches in Pediatrics
Meshael M Alkusayer1, Amjad S Alharbi2, Norah M Aljabri2
1ENT Department, King Saud Medical City, Riyadh, Saudi Arabia.
Insights
Internal jugular vein phlebectasia (IJVP) is a rare pediatric vascular anomaly. Conservative management is often effective for IJVP, with treatment tailored to individual cases.
Area of Science:
- Vascular Surgery
- Pediatric Radiology
- Medical Genetics
Background:
- Internal jugular vein phlebectasia (IJVP) is a rare, benign vascular anomaly characterized by dilatation of the internal jugular vein, predominantly affecting pediatric patients.
- Current treatment strategies for IJVP lack consensus, necessitating a comprehensive review of existing literature to guide clinical practice.
Approach:
- A systematic literature review was conducted, searching five databases until October 10, 2022, for all study designs reporting on IJVP in pediatric subjects.
- Data extracted included patient demographics, clinical manifestations, diagnostic imaging methods, management approaches, and outcomes, with quality assessed using the Joanna Briggs Institute's Critical Appraisal Checklist.
Key Points:
- The review analyzed 51 articles comprising 169 pediatric cases, predominantly male, with the right internal jugular vein most frequently involved (77%).
- Common symptoms included neck swelling and dyspnea, with swelling exacerbating during the Valsalva maneuver in 90% of cases.
- Diagnosis was confirmed via ultrasonography, CECT, or color Doppler; management was primarily conservative or surgical (ligation), with no reported serious complications.
Conclusions:
- IJVP is a rare, benign condition in children, typically affecting the right internal jugular vein.
- Conservative treatment with monitoring is recommended, though management should be individualized based on case-specific factors.
- The condition generally has a favorable prognosis, with most patients responding well to conservative measures.
Objectives:
Internal jugular vein phlebectasia (IJVP) is a rare type of vascular abnormality that causes dilatation of internal jugular vein in the neck. There is presently no consensus on the most effective method of treatment for this condition, that is commonly seen in children. We conducted a systematic review of the literature reported till date to comprehend the key features of IJVP and its most effective therapeutic modalities.
Methods:
Five databases were searched until October 10, 2022 for articles of any design (including case reports) reporting IJVP in pediatric subjects. Individual patient data on demographics, clinical features of this entity and the differential diagnosis, methods of imaging, management, and outcome of illness were recorded. The quality assessment was performed using the Joanna Briggs Institute's Critical Appraisal Checklist for studies.
Results:
A total of 51 articles including 169 cases were retrieved and included in the analysis. Of the 169 patients, most of them were male children, and in 77% of cases right internal Juglar vein was involved. All patients had some symptoms suggestive of IJVP with most common ones being neck swelling or tenderness, and difficulty in breathing. In 90% of cases, it was observed that the neck swelling typically increases in size with Valsalva maneuver. Once jugular vein phlebectasia was clinically suspected, ultrasonography, CECT, or color Doppler flow imaging were used to confirm the diagnosis. The management of most of the cases was either conservative or surgical, and in surgery mostly ligation was performed. There have not been any cases of serious complications, therefore, according to included studies, a conservative approach is recommended with continuous monitoring. Out of the 51 studies included, most of them had low risk of bias.
Conclusion:
Internal jugular vein phlebectasia, a rare benign condition, is most commonly found in children, and affects predominantly the right internal jugular vein. Although most patients did well with merely conservative treatment, still management of this vascular anomaly has to be on a case-by-case basis.
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