Veinguard: a rare case of an external jugular vein angioma

Neck masses are common, but primary vascular tumors of the external jugular vein are exceptionally rare and often overlooked in differential diagnoses. This case is notable for its prolonged course, distinctive clinical presentation, and histological confirmation, underscoring the value of imaging, surgical excision, and attention to cosmetic outcomes.

We describe a 20-year-old female who presented with an 8-year history of a progressively enlarging right-sided neck swelling that became painful in the past 2 years. On examination, a 3 × 2 cm nonreducible mass with bluish discoloration was noted in the lower anterior triangle of the neck, which enlarged on coughing and during the Valsalva maneuver. Initial imaging with ultrasonography revealed a vascular lesion, further characterized by CT angiography as a 20 × 15 mm enhancing mass attached to the right external jugular vein. Surgical excision was performed under general anesthesia. Intraoperatively, a well-circumscribed vascular mass was found adjacent to the sternocleidomastoid muscle and excised completely. Histopathological analysis confirmed a benign venous angioma.

Vascular tumors of the external jugular vein are exceptionally uncommon and often absent from routine differential diagnoses. Their clinical presentation may mimic benign cysts or lymphadenopathy, contributing to diagnostic uncertainty. Imaging helps narrow the diagnosis but cannot confirm histology. Surgical excision is essential for both definitive diagnosis and symptom relief. In this case, the patient also had aesthetic concerns, which were addressed successfully with a concealed incision and uneventful recovery.

Venous angioma of the external jugular vein is a rare differential for neck masses. Surgical excision remains the mainstay for diagnosis and management, with excellent long-term outcomes.