J Med Cases

Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Med Cases and Elmer Press Inc

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Case Report

Volume 17, Number 7, July 2026, pages 348-355

Cephalic Venous Aneurysm and Intravascular Papillary Endothelial Hyperplasia in a Blood Donor

↓ Figure 1. Physical examination of the patient revealed a 25-mm soft, non-pulsatile mass in the right antecubital fossa. Tenderness and the absence of a bruit were also noted.

↓ Figure 2. Venous duplex ultrasound of the right cephalic vein revealed saccular dilatation measuring 15.6 × 7.8 × 25.5 mm with hyperechogenic intraluminal material consistent with superficial venous aneurysm and thrombosis.

↓ Figure 3. (a) Intraoperative image showing ligation of the afferent and efferent venous branches, and excision of the cephalic vein aneurysm. (b) Surgical specimen of the resected cephalic vein aneurysm.

↓ Figure 4. (a) Microphotograph depicting a transverse section of the vessel with dilatation of the lumen as well as disorganization (markedly reduced) of the muscle layer and the elastic fiber network. Hematoxylin and eosin stain was used at × 25 magnification. (b) The network of elastic fibers is disrupted and replaced. Collagen fibers replace smooth muscle and elastic fibers consistent with endophlebosclerosis. Van-Gieson stain was used at × 100 magnification.

↓ Figure 5. (a) Microphotograph depicting a transverse section in hematoxylin and eosin stain (H&E) of the vessel with dilatation of the lumen, as well as the presence of intravascular papillary endothelial hyperplasia. Hematoxylin and eosin stain was used at × 25 magnification. (b) A focus of intravascular papillary endothelial hyperplasia is shown, composed of numerous papillary structures lined by plump endothelial cells. Hematoxylin and eosin stain was used at × 100 magnification.

↓ Figure 6. The selection process of suitable cases for the literature review is presented in a flow diagram.

↓ **Table 1.** Reported Cases in the Literature, Including the Present Case, Regarding Upper-Extremity Venous Aneurysms and Pseudoaneurysms Secondary to Venipuncture or Peripheral Vein Cannulation
Author/year	No.	Anticoagulation	Age (years)/sex/vein	Etiology/onset	Clinical presentation	Size (mm)	Imaging	Treatment	Follow-up	Histopathology
IPEH: intravascular papillary endothelial hyperplasia; MRI: magnetic resonance imaging; US: ultrasound; VA: venous aneurysm; VPA: venous pseudoaneurysm.
Niimi et al, 2017 [16]	1	No	58/female/right basilic vein	Blood sampling/3 years	Non-pulsatile antecubital mass with compression of the lateral antebrachial cutaneous nerve	24 × 19	Duplex US, MRI: VPA with thrombus	Persistent thrombus despite anticoagulation Successful surgical resection with ligation	2 years; no recurrence	VPA: dilatation with a thickened intima and media
	2	No	56/female/left basilic vein	Venipuncture/2 months	Non-pulsatile antecubital mass	23 × 17	Duplex US, MRI: VPA	Successful surgical resection	6 months; no recurrence	VPA: dilatation with thrombus
Ward et al, 2009 [14]	3	Yes	64/male/right basilic vein	Venipuncture/immediately	Non-pulsatile antecubital mass	40 × 30 position-dependent	B-mode and duplex US: 43 × 33 × 20 mm cavity with low-pressure swirling flow	Unsuccessful compression Successful surgical resection with ligation	n/a	VPA: lack of endothelial lining
Lotfi et al, 2007 [10]	4	No	43/male/left median antecubital vein	Venipuncture for blood donation/immediately	Non-pulsatile, tender antecubital mass	30 position-dependent	US: 30 × 15 mm cystic lesion with thrombosis Doppler analysis: swirling flow	Successful surgical resection and repair of the puncture site	n/a	VPA: lack of vascular wall with granulation tissue and thrombosis
Chakraborty et al, 1999 [13]	5	Yes	57/female/left antecubital vein	Venipuncture/immediately	Non-pulsatile, tender antecubital mass	45	US, venography: compressible VPA	Successful embolization	6 weeks; no recurrence	n/a
Debnath et al, 2007 [5]	6	No	45/female/right median cubital vein	Peripheral intravenous line/few months	Non-pulsatile, non-tender antecubital mass	20 × 30	Duplex US: VA	Successful surgical resection with ligation	n/a	VA: preservation of three layers, thickened media, and congested lumen
Perler, 1990 [15]	7	No	39/female/unspecified	Peripheral intravenous line/immediately	Non-pulsatile, non-tender wrist mass	35 × 15	Venous Doppler analysis; normal Venography: VA	Surgical resection with ligation	n/a	VA
Our case	8	No	52/male/right cephalic vein	Venipuncture for blood donation/unspecified	Non-pulsatile, tender antecubital mass	25 position-dependent	Duplex US: saccular dilation (15.6 × 7.8 × 25.5 mm) with thrombus	Anticoagulation and surgical resection with ligation	2 weeks; no recurrence	VA: dilation of the vascular lumen with disorganization of the vascular wall; endophlebosclerosis and IPEH

↓ Table 1. Reported Cases in the Literature, Including the Present Case, Regarding Upper-Extremity Venous Aneurysms and Pseudoaneurysms Secondary to Venipuncture or Peripheral Vein Cannulation

Author/year

No.

Anticoagulation

Age (years)/sex/vein

Etiology/onset

Clinical presentation

Size (mm)

Imaging

Treatment

Follow-up

Histopathology

IPEH: intravascular papillary endothelial hyperplasia; MRI: magnetic resonance imaging; US: ultrasound; VA: venous aneurysm; VPA: venous pseudoaneurysm.

Niimi et al, 2017 [16]

58/female/right basilic vein

Blood sampling/3 years

Non-pulsatile antecubital mass with compression of the lateral antebrachial cutaneous nerve

24 × 19

Duplex US, MRI: VPA with thrombus

Persistent thrombus despite anticoagulation
Successful surgical resection with ligation

2 years; no recurrence

VPA: dilatation with a thickened intima and media

56/female/left basilic vein

Venipuncture/2 months

Non-pulsatile antecubital mass

23 × 17

Duplex US, MRI: VPA

Successful surgical resection

6 months; no recurrence

VPA: dilatation with thrombus

Ward et al, 2009 [14]

Yes

64/male/right basilic vein

Venipuncture/immediately

Non-pulsatile antecubital mass

40 × 30
position-dependent

B-mode and duplex US: 43 × 33 × 20 mm cavity with low-pressure swirling flow

Unsuccessful compression
Successful surgical resection with ligation

n/a

VPA: lack of endothelial lining

Lotfi et al, 2007 [10]

43/male/left median antecubital vein

Venipuncture for blood donation/immediately

Non-pulsatile, tender antecubital mass

30
position-dependent

US: 30 × 15 mm cystic lesion with thrombosis
Doppler analysis: swirling flow

Successful surgical resection and repair of the puncture site

n/a

VPA: lack of vascular wall with granulation tissue and thrombosis

Chakraborty et al, 1999 [13]

Yes

57/female/left antecubital vein

Venipuncture/immediately

Non-pulsatile, tender antecubital mass

US, venography: compressible VPA

Successful embolization

6 weeks; no recurrence

n/a

Debnath et al, 2007 [5]

45/female/right median cubital vein

Peripheral intravenous line/few months

Non-pulsatile, non-tender antecubital mass

20 × 30

Duplex US: VA

Successful surgical resection with ligation

n/a

VA: preservation of three layers, thickened media, and congested lumen

Perler, 1990 [15]

39/female/unspecified

Peripheral intravenous line/immediately

Non-pulsatile, non-tender wrist mass

35 × 15

Venous Doppler analysis; normal
Venography: VA

Surgical resection with ligation

n/a

Our case

52/male/right cephalic vein

Venipuncture for blood donation/unspecified

Non-pulsatile, tender antecubital mass

25
position-dependent

Duplex US: saccular dilation (15.6 × 7.8 × 25.5 mm) with thrombus

Anticoagulation and surgical resection with ligation

2 weeks; no recurrence

VA: dilation of the vascular lumen with disorganization of the vascular wall; endophlebosclerosis and IPEH