We describe a 7-year-old child who presented with a soft fluctuant swelling
on the neck which became more prominent during the Valsalva manoeuvre. He
underwent adeno-tonsillectomy based on a mistaken diagnosis of ballooning o
f the pharynx secondary to enlarged adenoids and tonsils obstructing the na
sopharyngeal and oropharyngeal airways. Investigations revealed the swellin
g to be a markedly dilated internal jugular vein. We discuss the diagnostic
features and mode of treatment of this condition so as to avoid unnecessar
y and dangerous surgical intervention.