Manish Munjal, Japneet Kaur, Porshia Rishi, Nitika Tuli, Harjinder Singh
We report a case of 27-year-old female patient who presented with swelling on the right side of neck for 6 months. On examination the swelling was soft compressible non tender, with no local rise of temperature, roughly 2*3 cm in size. MRI of the neck showed a small 2.2*0.8*2.4 cm sized well defined T2W and STIR hyperintense and T1W hypointense lesion in the subcutaneous plane over the lateral aspect of the middle third of the neck. Posteriorly it was abutting the right external jugular vein without any thrombosis. Medially abutting the right sternocleidomastoid muscle. The patient was taken up for resection of the AVM under general anaesthesia. Round 5 cm linear vertical incision was put on the right side along the anterior border of sternocleidomastoid muscle at the level of greater cornua of hyoid bone. A vascular 2*2*2 cm mass was noted abutting the sternocleidomastoid muscle medially and internal jugular vein laterally. Blunt dissection was done. The mass was excised completely by separating from sternocleidomastoid muscle and internal jugular vein. All the feeding vessels from the internal jugular vein were individually identified and ligated and the mass was removed completely with minimal intra-operative bleeding. The bed was inspected thoroughly for any bleeding and after achieving haemostasis the wound site was closed in layers. The tissue was sent for histopathological examination. Histopathology was consistent with that of arteriovenous malformation showing admixture of malformed capillaries, arteries and venules with involvement of submucosa but not muscularis propria. The patient was asymptomatic at 3 months follow up and wound site showed complete healing with no scarring.
