EP06.52: “Veiled Intrigue” scalp hemangioma masquerading as a thickened nuchal fold

Scalp hemangiomas are benign vascular tumours occurring in infancy, presenting as cutaneous lesions with characteristic features. Occurrence prenatally mimicking a thickened nuchal fold, is rare and a diagnostic challenge. A 21 years primigravida referred for anomaly scan revealed a thickened nuchal fold measuring 7mm which was eccentric towards the left of midline (see figure 1). No underlying osseous defect seen in the occipital bone. On grey scale cystic areas were seen in the thickened nuchal fold which showed spontaneous 2D contrast. Colour Doppler showed spontaneous flow within the cystic areas of the thickened nuchal fold and spectral Doppler showed high velocity low impedance flow suggestive of a vascular malformation (see figure 2). Arterial supply seen from occipital artery and venous drainage malformation seen draining into the dilated left subclavian and internal jugular vein more prominent in comparison to the right sided neck veins (see figure 3b,c). The left half of transverse sinus (see figure 3a) was dilated suggesting intracranial venous drainage of the vascular malformation. Fetal echocardiography showed dilated right atrium and right ventricle and narrow aortic arch (see figure 4). The parents opted for termination of pregnancy. On autopsy (see figure 5) and histopathology (see figure 6)the findings of scalp hemangioma both capillary and cavernous type with coarctation of aorta were confirmed. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.