External jugular vein vascular malformation: sonographic and MR imaging appearances

Abstract

Vascular malformations arising from the wall of the external jugular vein are rare. This case series discusses the sonographic and MR imaging appearances of four such cases and reviews the literature. The diagnosis should be suggested preoperatively particularly because of the close relationship such malformations to the external jugular vein, as this helps surgeons to plan the operative procedure. The imaging appearances are similar to those of other vascular malformations elsewhere in the head and neck.

Fig 1.

Case 1. Sonographic and MR images obtained in a 31-year-old Indonesian woman with a vascular malformation of the left external jugular vein. A, Transverse power Doppler sonography shows vascularity within a well-defined, hypoechoic, heterogeneous mass. B, Axial T1-weighed fat-suppressed contrast-enhanced MR imaging image (TR/TE, 450/15) shows intense enhancement of the mass (arrows) and its relationship to the left external jugular vein (arrowhead).

Fig 2.

Case 2. Sonographic and MR images obtained in a 21-year-old woman with a left external jugular vein vascular malformation. A, Transverse gray-scale sonography shows a hypoechoic heterogeneous mass (arrows) closely related to the external jugular vein (arrowheads). B, Longitudinal gray-scale sonography shows a phlebolith (arrowheads) within the mass (arrows). C, Axial T1-weighed spin-echo MR imaging image (TR/TE, 425/12) shows an isointense mass (arrows) closely related to the left external jugular vein (arrowhead). It is closely abutting the posterior edge of the left sternocleidomastoid muscle (asterisk).

Fig 3.

Case 2. Pathologic and histologic sections of a specimen obtained by excision of the left external jugular vein vascular malformation. A, Gross specimen of the excised lesion shows a well-circumscribed mass with the proximal and distal vascular stumps of the external jugular vein. B, High-power histologic view of the vascular channels. Note the lining flattened endothelial cells (arrowhead) and the red cells inside the lumens. (Hematoxylin-eosin stain, original magnification, ×120.)

Fig 4.

Case 3. Sonographic and MR images obtained in a 37-year-old man with right external jugular vein vascular malformation. A, Transverse gray-scale sonography shows an ill-defined, hypoechoic, heterogeneous mass (arrows) inseparable from the external jugular vein (arrowheads). B, Axial T1-weighed spin-echo MR imaging image (TR/TE, 425/18) shows a slightly hyperintense mass (arrows) with ill-defined edges closely related to the right external jugular vein (arrowhead). C, Axial fat-suppressed T2-weighed MR imaging image (TR/TE, 2500/108) shows a hyperintense mass (arrows) closely related to and inseparable from the right external jugular vein (arrowhead). Note its infiltration into the adjacent sternocleidomastoid muscle.