Presentation
Golf-ball sized painless neck swelling in the right lower posterior triangle which has been increasing in size over 1 year and most prominent on lying down. In addition, patient was experiencing pressure symptoms and tightness on the ipsilateral side of the face along with right hemi-cranial headache/retro-orbital pain.
Patient Data
2.6 cm mixed attenuation rounded object in relation to the right external jugular vein (EJV).
Appearances are most in keeping with a venous pseudoaneurysm originating from the EJV at the level of the thyroid gland. The remainder of the neck vessels are normal. No concerning lymphadenopathy.
Case Discussion
A pseudoaneurysm is an injury to the vessel wall with leaking blood collects in the surrounding tissue.
Venous aneurysm or pseudoaneurysm falls within the differential diagnosis of lateral neck masses, which includes neoplasms, infection/abscess, vascular or congenital abnormalities.
Both venous aneurysms and pseudoaneurysms are very rare clinical entities. According to Calligaro et al., only 5 cases were recorded over 20 years in their institution.
US scan can be a useful first investigation to differentiate a pseudoaneurysm from other neck masses like an enlarged lymph node, arterial aneurysm or a mass such as hemangioma. CT or MRA can help to further confirm the diagnosis.