Common facial vein aneurysm with tributary to the external jugular vein

Venous aneurysms in the head-and-neck region are relatively rare, and facial vein aneurysms are particularly unusual. The common facial vein typically drains into the internal jugular vein, while anomalous tributaries connecting to the external jugular vein (EJV) are infrequently described. High-resolution ultrasonography with Doppler and contrast-enhanced computed tomography (CECT) play an important role in diagnosing such vascular anomalies and delineating their complex anatomy. We report the case of a 43-year-old female presenting with a longstanding, soft, compressible swelling in the right cheek and neck region. Duplex ultrasound demonstrated a fusiform dilatation with venous flow that was phasic and augmented with Valsalva, and was continuous with the facial venous system. CECT revealed a well-enhancing aneurysmal outpouching of the common facial vein, with communicating tributaries draining into the EJV. No thrombus or secondary cause was identified. A diagnosis of common facial vein aneurysm communicating with the EJV through a tributary was made, and the patient was managed conservatively with a defined follow-up plan. Recognition of variant venous anatomy, including facial–EJV communications, and the combined use of ultrasonography and CECT allow accurate diagnosis and anatomical mapping. Awareness of this rare entity is important to avoid misdiagnosis and to guide appropriate management and surgical planning.