Non-operative Approach to an Incidental Internal Jugular Venous Aneurysm: A Case Report.

Internal jugular venous aneurysms (IJVAs) are rare vascular malformations that usually manifest as soft, pulsatile neck masses that are often misdiagnosed. In this case, we present a 70-year-old man with fatigue, dyspnea, and an intermittent pulsating neck sensation in the setting of acute anemia. Computed tomography angiography (CTA) revealed a 2.7 cm saccular aneurysm of the left internal jugular vein with no thrombus. Normally, these aneurysms are asymptomatic; however, they may be surgically remediable on a case-by-case basis, depending on the presence of symptoms, aneurysm morphology, fragility of the vessel wall, and complication risk. Given our patient's resolving symptoms with correction of anemia, absence of residual paresthesias, and overall surgical risk, conservative management was chosen. There is little literature on IJVAs, particularly in the context of management in the elderly with co-morbid illnesses. This report stresses the need for personalized treatment modalities and contributes to the literature regarding the management options of this rare vascular entity.