A 3-month-old girl, born at term, presented for evaluation of multiple vascular skin lesions on the face. The lower-lip lesion had been noted at 2 weeks of age, with the others developing over weeks on the right temple, left chin, left ear, and submental region. The lesions appeared to be asymptomatic without any bleeding or breakdown, and her parents denied breathing or feeding difficulties. She was otherwise healthy and was reaching normal developmental milestones.Physical examination revealed a vascular red thin plaque on the right lower lip (Figure , A), with speckled vascular papules on the left temporal scalp (Figure , B), left neck, and left chin and submental region (Figure , C), all felt to be consistent with infantile hemangiomas. There was no hoarseness or stridor. Full skin examination was performed and revealed an atrophic sternal pit and a smaller midline superior abdominal atrophic defect (Figure , D). Given her constellation of findings, magnetic resonance (MR)
Vascular malformations include a spectrum of clinical presentations with various radiologic and histologic findings. They can present a diagnostic and therapeutic challenge to clinicians and often require a multidisciplinary approach. Our patient’s imaging findings were not congruent with the clinical presentation of digital overgrowth prompting additional investigative studies. To the best of our knowledge, this is the first reported case of iatrogenic venous arterialization in a pediatric patient, with concomitant overgrowth of the first toe, treated successfully with coil embolization.
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