Self-regressing scalp arteriovenous malformation in a neonate

Congenital AV malformations of scalp are rare congenital vascular malformations and often misdiagnosed as hemangiomas. Only 3 cases of neonatal scalp AVM have been reported till date. We report a rare case of self regressing scalp AV malformation in a neonate. An hour old full term female baby, presented with a soft, pulsatile large lesion (5cm x 4cm) with elevated borders and crusting over left parieto-occipital area, with bruit on auscultation. The infant had a soft cardiac murmur. USG cranium was likely suggestive of AV malformation or cephalhematoma. MR brain venography showed extra-calvarial network of multiple dilated tortuous veins draining into the left transverse sinus, sigmoid sinus and IJV. CT brain with CT carotid angiography revealed multiple arterial feeders from the left ECA and its branches, middle meningeal artery and left vertebral artery with multiple venous channels seen draining into the left transverse sinus, sigmoid sinus, IJV and EJV, the possibilities were arteriovenous malformation and less likely infantile hemangioma. Echocardiography showed small midmuscular VSD. Endovascular embolization was planned but didn't do immediately as the baby didn't show any signs of cardiac failure. The baby is on regular follow up and is growing well, with the lesion being regressing on its own. The baby doesn't have any signs of cardiac failure till now, hence only supportive care is being given. Early detection and comprehensive management of AVM result in a positive outcome. Embolization is only recommended if benefit outweighs the risk.