Beyond Vocal Nodules: Bilateral Internal Jugular Phlebectasia Presenting With Progressive Dysphonia in an Adult Woman

Jugular phlebectasia is a rare vascular anomaly characterized by a congenital, benign, fusiform dilation of the jugular vein, typically presenting as a soft, non-pulsatile cervical swelling that becomes evident during maneuvers that increase intrathoracic pressure. Although most cases are asymptomatic and diagnosed during childhood, adult presentations - particularly bilateral involvement - remain exceptionally uncommon and may pose a diagnostic challenge due to their resemblance to other cervical masses. When symptomatic, patients may report dysphonia, dysphagia, local discomfort, or cosmetic concerns, depending on the degree of venous dilitation and anatomical relationships. We report the case of a 52-year-old woman who presented with a long-standing history of progressive dysphonia and intermittent cervical discomfort, initially attributed to laryngeal nodules. Over time, her symptoms evolved, prompting further evaluation. Physical examination revealed a bilateral, soft, compressible cervical mass that became prominent during the Valsalva maneuver and completely regressed at rest, raising suspicion of a dynamic vascular process. Doppler ultrasonography demonstrated marked fusiform dilation of both internal jugular veins with preserved venous flow and no evidence of thrombosis. These findings were further characterized by CT angiography, which confirmed bilateral jugular phlebectasia without associated vascular malformations, flow disturbances, or extrinsic compression. Given the absence of complications such as thrombosis, rapid enlargement, or airway compromise, and considering the potential risks associated with surgical intervention, a conservative management approach was adopted. The patient was managed with clinical surveillance and symptom-oriented measures, with stable evolution during follow-up. This case highlights the importance of a thorough clinical examination and the recognition of dynamic cervical masses, particularly those associated with Valsalva maneuvers, to avoid misdiagnosis and unnecessary invasive procedures. Furthermore, it underscores the critical role of non-invasive imaging modalities, especially Doppler ultrasound and CT angiography, in establishing an accurate diagnosis. The rarity of bilateral jugular phlebectasia in adults makes this report a valuable contribution to the literature, reinforcing awareness of this benign condition and supporting conservative management in appropriately selected patients.