Internal jugular vein vascular malformation presenting as mass at root of neck: a case report

A 27 year male presented with a gradually enlarging, asymptomatic swelling on left supraclavicular region with normal overlying skin. A soft mass, about 7 × 7 cm with restricted mobility was found with normal cranial nerve function. Fine needle aspiration cytology showed a hemorrhagic aspirate. Doppler showed a mass displacing left carotid artery posteriorly while left internal jugular vein was not visualized. Magnetic resonance imaging showed a well defined mass isointense to hypointense on T1 weighted and hyperintense on T2 weighted and STIR images with fluid-fluid levels. On exploration, a vascular mass arising from left internal jugular vein was found with good tissue planes, which was excised after ligating the patent internal jugular vein above and below the lesion. Histopathologic examination confirmed the diagnosis of vascular malformation.The diagnosis of intrinsic vascular malformation arising from internal jugular vein should be kept in differential while dealing with masses at root of neck and magnetic resonance imaging features may help in the pre-operative diagnosis of this entity.Vascular lesions have been classified as hemangiomas or vascular malformations depending on the presence of cellular proliferation [1]. Venous vascular malformations may present as isolated neck masses in adults without the clinical findings typically associated with vascular malformations like skin discolouration, dilated subcutaneous vessels and compressibility [2]. Among the vessels of jugular system in the neck, intrinsic vascular malformations have been described arising from the external jugular vein [3,4]. We report a case of intrinsic vascular malformation arising from internal jugular vein presenting as mass at the root of neck with clinical and radiological features suggesting a mass in relation with major vessels of neck. Final diagnosis was established only after surgical excision and histopathology. This is the first reported case of an intrinsic vascular malform