Neonate with a large neck mass

A male term infant, with polyhydramnios, was delivered by caesarean section. Family history included a sibling with Edward’s syndrome. He required non-invasive respiratory support at birth and was admitted to the neonatal unit. A raised occipital mass was noted (figure 1), measuring 8×6 cm, with central yellow pallor and surrounding margins of purple convoluted friable skin and overlying telangiectasia. There was a strong palpable pulse felt above the mass. Figure 1 Large neck swelling noted on base of occiput. The baby remained haemodynamically stable (admission blood pressure 69/37mmhg) with normal values for both haemoglobin (152 g/L) and platelet count (149×109/L). He was transferred to a tertiary hospital where ultrasound (USS) demonstrated a mass with high intralesional vascular flow (figure 2). MRI demonstrated a large congenital vascular anomaly within the posterior neck soft tissues and identified large feeding and draining vessels. Figure 2 B-mode ultrasound image …