Right internal jugular vein ectasia: unmasking a rare cause of neck swelling in an adult Nepalese male - a case report.

Introduction: Internal jugular vein ectasia (IJVE) is a rare venous anomaly presenting as unilateral neck swelling that is predominantly observed in childhood and infrequently reported in adults. Notably, fewer than 100 cases have been documented worldwide, emphasizing its rarity.This case highlights a 61-year-old Nepalese male with IJVE, notable for its atypical adult onset and right sided presentation. Case presentation: The patient presented with painless, intermittent swelling that worsened with activities increasing intrathoracic pressure. Clinical examination revealed a soft, pulsatile, fusiform swelling in the right lower neck, well-demarcated along the sternocleidomastoid muscle. The swelling enlarged during the Valsalva maneuver, and ultrasound confirmed IJVE without complications. Given his history of stroke and residual dysphagia, it is important to note that the IJVE's onset appears coincidental rather than causally related. Discussion: The exact cause of IJVE remains unclear. Often discovered incidentally, the diagnosis requires differentiation from other neck masses. A detailed history, physical examination, and early use of ultrasound - a low-cost, low risk, and highly accessible imaging modality with high availability and minimal financial burden worldwide - are critical for accurate diagnosis. Conservative management is typically sufficient, with surgery reserved for significant symptoms or cosmetic concerns. Conclusion: This case underscores the importance of considering IJVE in the differential diagnosis of neck masses, particularly in adults with atypical symptoms. Thorough evaluation and imaging - especially early ultrasound use - play a crucial role in accurate diagnosis and avoiding unnecessary interventions.