Phlebectasia

Phlebectasia refers to dilation of a vein—usually a congenital, fusiform dilation of a venous segment without true aneurysmal sac formation—also called venous ectasia when the term is used more broadly. The most common manifestation is jugular phlebectasia, particularly internal jugular vein, though veins elsewhere (external jugular, thoracic veins) can be involved.

In children, jugular phlebectasia presents as a soft, compressible neck swelling on one side that enlarges during crying, coughing, or Valsalva and recedes at rest; the lesion is typically non-tender, nonpulsatile; usually unilateral; incidental findings possible.

Duplex ultrasonography with Doppler shows fusiform dilation of a venous segment with preserved flow; size increases with Valsalva; CT or MRI may delineate anatomy and exclude other causes (cystic hygroma, laryngocele, branchial cleft cyst, venous malformations).

Most cases are benign and managed conservatively with observation; avoid surgical intervention unless symptomatic, enlarging, or causing cosmetic concerns or if diagnosis is uncertain; surgical options include resection or ligation of the dilated segment with care to preserve venous drainage.

Outcome is generally excellent; rare complications include thrombosis or rupture; recurrence is uncommon if monitored.