Radiological Category Pediatrics Principal Modality 1 Ultrasound Principal

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Radiological Category: Pediatrics Principal Modality (1): Ultrasound Principal Modality (2): MRI Case Report 0977

Radiological Category: Pediatrics Principal Modality (1): Ultrasound Principal Modality (2): MRI Case Report 0977 Submitted by: Tina Lee, MD Faculty reviewer: Lawrence Robinson, MD Date accepted: 01 February 2013

Case History 2 month old female with red-blue discoloration over the posterior fontanelle.

Case History 2 month old female with red-blue discoloration over the posterior fontanelle.

ULTRASOUND

ULTRASOUND

ULTRASOUND

ULTRASOUND

MRV

MRV

MRV

MRV

MRV

MRV

MRV

MRV

Test Your Diagnosis Which one of the following is your choice for the appropriate

Test Your Diagnosis Which one of the following is your choice for the appropriate diagnosis? After your selection, go to next page. • Vessel containing cephalocele • Sinus pericranii • Infantile hemangioma • Arteriovenous malformation

Findings and Differentials Findings: There is an abnormal connection between the scalp venous drainage

Findings and Differentials Findings: There is an abnormal connection between the scalp venous drainage and the intracranial venous drainage. On the ultrasound images a vessel is seen draining the scalp and entering the superior sagittal sinus. The MRV confirms a mildly enlarged scalp varix traversing the cranium and draining into the superior sagittal sinus. Differentials: • Sinus Pericranii • Vessel containing cephalocele

Discussion Sinus pericranii is a venous anomaly involving a connection between the intracranial and

Discussion Sinus pericranii is a venous anomaly involving a connection between the intracranial and extracranial venous drainage pathways. It can be congenital in as in this case, or acquired (generally through trauma). Typically the communication is between a scalp varix or prominent scalp vein and a dural venous sinus. Clinically Sinus pericranii presents as a fluctuant, nontender, reducible bluish colored mass on the scalp. This may reduce upon upright position or enlarge upon supine positioning or Valsalva maneuver. Typically it is asymptomatic, but can present with headache, nausea, dizziness. There is an association with developmental venous anomalies, Blue-Rubber Nevus Syndrome, systemic/multiple vascular malformations and multisutural craniosynostosis. Evaluation in the pediatric patient can be performed with ultrasound, CTV or MRV. The anomalous connection is typically midline or parasagittal in location; Frontal 40%, Parietal 34%, Occipital 23%, Temporal 4% Treatment is surgical as there is a risk of hemorrhage and infection.

Diagnosis Sinus Pericranii

Diagnosis Sinus Pericranii

References Illner, A. DX: Sinus Pericranii (Retrieved January 28, 2013) from www. statdx. com

References Illner, A. DX: Sinus Pericranii (Retrieved January 28, 2013) from www. statdx. com Gandolfo, C et al (Jun 2007) Sinus Pericranii: diagnostic and therapeutic consideration in 15 patients. Neuroradiology 49(6): 505 -14