Scalp congenital hemangioma with associated high-output cardiac failure in a premature infant: Case report and review of literature

Sumedh S. Shah, Brian M. Snelling, Samir Sur, Alexandra R. Ramnath, Emmalee S. Bandstra, Dileep R. Yavagal

Research output: Contribution to journalArticle

Abstract

Introduction: Scalp congenital hemangiomas (CHs) are rare vascular malformations among infants; they can be associated with an array of complications, including cardiac and cosmetic issues. Here, we report the endovascular treatment of a premature infant with a suspected large right parietal scalp hemangioma and associated high-output cardiac failure. Case description: A two-day-old female premature infant (29 weeks gestational age; 1330 g birth weight) was referred by the neonatologists to our department for consultation and potential treatment of a large right parietal CH causing abrupt hypotension and high-output cardiac failure. Doppler ultrasound imaging at bedside revealed areas of arterial-venous shunting from the scalp and the presence of a superior sagittal sinus waveform, consistent with intracranial venous drainage. To alleviate cardiac dysfunction secondary to this lesion, trans-arterial embolization via n-butyl cyanoacrylate (nBCA) glue and deployment of detachable coils was performed via umbilical artery to occlude the right superficial temporal and occipital artery branches supplying the CH. Following treatment, the infant continued to require ventilator management, vasopressor support, and correction of coagulopathy, but by post-operative day two, her condition improved remarkably and the mass size began decreasing. The patient was discharged after a relatively uncomplicated subsequent 2-month course in the neonatal intensive care unit. Conclusion: Endovascular therapy proved effective and safe in treating cardiac failure associated with scalp CH, despite potential complications associated with neuro-interventional surgery in premature infants. Appropriate consideration in this patient population should be given to factors including blood loss, contrast use, radiation exposure, operative time, and possible intra-/post-operative complications.

Original languageEnglish (US)
Pages (from-to)102-106
Number of pages5
JournalInterventional Neuroradiology
Volume23
Issue number1
DOIs
StatePublished - 2017

Keywords

  • Case report
  • Endovascular treatment
  • Heart failure
  • Premature infant
  • Rapid involuting congenital hemangioma
  • Scalp congenial hemangioma

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

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