Case Report

A 57-year old male patient of Afro-Trinidadian descent presented with a swelling on the left side of his neck for approximately 2-years. The lump was located in the posterior triangle and bulged-out on shouting or singing, then reduced spontaneously.

One week prior to presentation the lump became hard, tender and swollen. It did not reduce spontaneously. On clinical examination, there was a 2cm lump in diameter, firm consistency, had limited mobility in all planes, not attached to skin and located in the posterior triangle and posterior to the external jugular vein (implying the external jugular vein was not thrombosed. There was no history of trauma or venous canulation.

At operation, a thrombosed varix of the external jugular vein was found [Figures 1 and 2 and excised with ligation of the proximal and distal ends of the vein with 2.0 Vicryl sutures.

Figure 1

Figure 1: Varix of External Jugular Vein showing external jugular vein with instrument in the lumen

Figure 2

Figure 2: Varix of External Jugular Vein with thrombus within the varix.

Varices of the external jugular vein have been extensively reported in the literature with many case series and complications. The differentials include a sebaceous cyst and lipoma. There is always a risk of bleeding if one approaches such a lump without possible awareness of an external jugular varix.

We advise caution and proper history taking to avoid potential catastrophic complications with bleeding when such a lump presents in close proximity to the external jugular vein.