The presentation of a huge scalp hemangioma similar to an arteriovenous malformation presentation; case report and review of the literature

• RICH is a type of congenital hemangioma that presents at birth. • It has unique clinical, radiological, and histopathological features. • Diagnosis can be made prenatally through imaging modalities. • The disease course is usually benign and does not require treatment. • A multidisciplinary approach to diagnosis and treatment is recommended. Hemangiomas are the most common tumors of infancy, with a prevalence of 10–12 % by 1 year (3). They are classified as infantile or congenital (4). The congenital subtype was first described by Boon et al. in 1996 (5) and is divided into rapidly involuting congenital hemangiomas (RICH) and non-involuting congenital hemangiomas (NICH) (5,7,12). Herein, we report a neonate with a large, left extracranial scalp RICH detected at birth, accompanied by cutaneous features. This report also reviews the clinical characteristics and management of similar cases. A full-term female neonate presented with a large, well-defined left parietal-occipital mass extending to the upper posterior neck. The lesion was covered by intact skin and hair, displayed purple discoloration, and displaced the left ear anteriorly and slightly downward. Magnetic resonance imaging (MRI) revealed a large, heterogeneous, solid scalp mass in the left parieto-occipital region, with strong, heterogeneous enhancement and a small non-enhancing central area. A scalp RICH was diagnosed. The infant developed torticollis and left posterior positional plagiocephaly, which improved with physiotherapy. After one year, the mass had regressed, leaving partial alopecia. RICH presents at birth and exhibits distinct clinical, radiological, angiographic, and histopathological features. Prenatal diagnosis is possible using imaging modalities. The condition typically follows a benign course and often regresses spontaneously, obviating treatment. However, RICH can lead to life-threatening complications that may require intervention. Effective management depends on understanding the disease course and patient status and should involve a multidisciplinary team.