Asymmetrical neck contour: Two rare venous vessel alterations with differing clinicalrelevance and contrary therapy

Background Venous changes are very rare causes of cervical asymmetries or masses. In pre-therapy, next to the clinical examination, imaging procedures, especially ultrasound, play an important role.

We present 2 cases of patients with cervical contour changes. In the first case, a 6-year-old boy presented with a slightly more prominent, non-painful right side of his neck. Duplex sonography showed a side difference in the diameter of the internal jugular vein. Ectasia was diagnosed. There is no need for therapy.

The second patient, a 75-year-old man, had a partly firm, partly soft, easily movable cervical mass on his right cervical side. Duplex sonography revealed an inhomogeneous, mostly hypoechogenic, mass adjacent to the external jugular vein (EJV). No blood flow in the EJV could be detected. In an additional cervical CT, this structure adjacent to the EJV showed peripheral contrast enhancement. An aneurysm of the EJV was diagnosed. This was surgically removed.

Conclusion Pathological, non-iatrogenic changes in the neck veins are very rare. Both venous ectasia and venous aneurysm can occur in all age groups. A safe, non-invasive diagnostic tool is duplex sonography, which can be complemented by other procedures such as Angio-MRI or -CT. A reliable diagnosis is essential since clinical relevance and therapy vary widely and this is the only way to prevent iatrogenic damage to the patient. E. g. aneurysms should not be tried to be punctured due to the risk of a thrombus being flushed out.

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Publication History

Article published online:
13 May 2021