Surgical management of an intraluminal thrombus in the external jugular vein: A case report with near-infrared visualization as a useful adjunct

Background: Surgical removal of a mass in the external jugular vein requires precise localization to ensure optimal cosmetic outcomes. While preoperative imaging is standard, intraoperative anatomical shifts can occur. We report a case where a near-infrared vein visualization device was used as a supplementary tool during the excision of an intraluminal thrombus. Case Description: A 50-year-old woman presented, complaining of a subcutaneous mass in the left neck. She used a sports bra for the previous 6 weeks to participate in a marathon race. Ultrasonography revealed an intraluminal mass arising from the venous wall of the left external jugular vein. This finding suggested that the mass could be a thrombus. An anticoagulant agent was initiated. However, the lesion was resistant to treatment and continued increasing. Therefore, we planned surgical removal of the subcutaneous mass. Before the design of a skin incision, we identified the subcutaneous mass using a near-infrared visualization device. The mass was accurately localized and dissected through a minimal 2-cm transverse skin incision. Pathological diagnosis was the combination of intravenous pyogenic granuloma and organized thrombus. There was no recurrence of the mass at the final follow-up of 2 years after surgery. Conclusion: We describe the successful removal of an intraluminal thrombus in the external jugular vein. Near-infrared vein visualization was found to be a useful adjunct in our experience.