BACKGROUND: Internal jugular phlebectasia (IJP) is an uncommon entity with only about 100 reported cases and with very few available cases in the literature. The current case study is about a male trainee fighter pilot incidentally diagnosed to have IJP. With limited literary evidence, it was a complex task to predict the prognosis of IJP and its implications on fighter flying.CASE REPORT: In order to confirm the diagnosis, a preliminary study was carried out to find out the normal and expanded area of the internal jugular vein (IJV) of 30 volunteers. The expanded area of the right IJV of the trainee pilot fell beyond 1 SD of the study population, confirming the diagnosis of IJP in the trainee pilot.DISCUSSION: Aeromedical concerns were the anti-G straining maneuver, positive pressure breathing for G, negative G_z, modified Valsalva maneuver, and rapid decompression. Considering the potential progression of IJP by repeated exposure to aviation stresses, the trainee pilot was re-assigned to helicopters.Khatua SS, Sannigrahi P, Dahiya M, Rastogi P, Raheem A. Aeromedical decision making in internal jugular phlebectasia. Aerosp Med Hum Perform. 2019; 90(2):132–134.