Giant Scalp Hemangioma in a Term Neonate: Diagnostic Challenges and Imaging Insights – A Case Report

Giant Scalp Hemangioma in a Term Neonate: Diagnostic Challenges and Imaging Insights – A Case Report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Giant Scalp Hemangioma in a Term Neonate: Diagnostic Challenges and Imaging Insights – A Case Report Abdullahi Ahmed Ahmed, Sahra Ali Yusuf This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8233462/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction: Benign newborn hemangiomatosis (BNH) is a rare, non-heritable, and typically self-resolving condition, characterized by multiple cutaneous neonatal hemangiomas (IH) with few or no visceral lesions. These lesions generally manifest between the second and eighth week of life and may be congenital (30%) or, more frequently, infantile (70%). Case Presentation: A male neonate, born at 38 weeks of gestation via spontaneous vaginal delivery to a 30-year-old gravida 8, para 6 woman with no prior medical history, presented with multiple cutaneous lesions. The pregnancy was uncomplicated, with normal prenatal laboratory findings and unremarkable fetal survey. Apgar scores were not documented due to the home birth setting. Discussion: This report contributes to the limited literature on prenatal detection of cranial hemangiomas by presenting a rare case of a rapidly involuting congenital hemangioma (RICH) identified in the third trimester. Although such prenatal diagnoses are uncommon, our findings align with prior reports indicating that in utero detectable hemangiomas generally appear after 26 weeks of gestation. Infantile hemangiomas, the most common benign vascular neoplasms in children, affect up to 4–5% of Caucasian infants and result from proliferation of endothelial-like cells. In this case, the lesions may reflect hemangiomatous disruption of developing hair follicles or represent a hamartomatous formation. Conclusion: Close monitoring and follow-up imaging during the first year of life are essential to assess lesion progression and involution. Recognizing the distinctive clinical and imaging features of cranial hemangiomas is critical to avoid unnecessary interventions and to implement appropriate management. This case underscores the importance of interdisciplinary collaboration in the care of neonates with vascular anomalies. Neonatal hemangioma benign newborn hemangiomatosis (BNH) rapidly involuting congenital hemangioma (RICH) cranial hemangioma vascular anomalies prenatal detection interdisciplinary management Figures Figure 1 Figure 2 INTRODUCTION Benign newborn hemangiomatosis (BNH) is an uncommon, non-heritable, and self-limiting condition, characterized by multiple cutaneous infantile hemangiomas (IH) with minimal or absent visceral involvement ( 1 ). These lesions typically appear between the second and eighth week of life and can be either congenital (approximately 30% of cases) or infantile in origin (around 70%) ( 2 ). While most infantile hemangiomas are identified postnatally, prenatal detection remains rare due to their late gestational emergence and subtle imaging characteristics ( 3 , 4 ). All infantile hemangiomas exhibit GLUT1 positivity on immunohistochemistry, a distinctive feature that differentiates them from other vascular tumors ( 4 ). This case is unique because it presents a rapidly involuting congenital hemangioma (RICH) located on the scalp, which was identified during the third trimester of pregnancy. Prenatal recognition of cranial hemangiomas is exceedingly rare, and such early detection allows for anticipatory planning, close postnatal monitoring, and timely multidisciplinary management. By documenting this case, we aim to contribute to the limited literature on prenatal cranial hemangiomas and emphasize the clinical and imaging features that can guide appropriate management in similar neonatal presentations. CASE PRESENTATION A male neonate, born at 38 weeks of gestation via normal spontaneous vaginal delivery to a 30-year-old gravida 8, para 6 mother, presented with a prominent parietal-occipital scalp mass. The mother had no pre-existing medical conditions, and the pregnancy was uncomplicated. Prenatal laboratory tests and fetal ultrasonography were unremarkable. There was no family history of vascular anomalies or congenital malformations. Apgar scores were undocumented due to delivery at home. The patient had no known psychosocial risk factors and was living in a supportive home environment. The primary concern upon presentation was the rapidly enlarging scalp mass with visible venous dilations, associated with mild respiratory compromise requiring ventilatory support. The infant exhibited no other acute symptoms such as feeding difficulties, cyanosis, or neurological deficits at the time of admission. On examination, the neonate appeared hemodynamically stable but required respiratory support via pressure support spontaneous mode, with a peak inspiratory pressure of 18 cm H₂O, PEEP of 6 cm H₂O, inspiratory time of 0.40 seconds, and FiO₂ of 40%, maintaining oxygen saturation between 92% and 93%. The scalp lesion measured [Figure 1 ], was soft, compressible, and non-tender, with prominent venous markings. Cranial sutures were widely patent, and both fontanelles were normal. Cardiovascular, respiratory, and abdominal examinations were unremarkable. Neurological assessment was appropriate for gestational age. Relevant interventions prior to presentation included supportive care at home; no previous surgical or pharmacological interventions had been administered. Following admission, mechanical ventilation was initiated to maintain adequate oxygenation. Imaging studies, including MRI, confirmed a large parietal-occipital scalp hemangioma. The clinical course can be summarized as follows: Birth at home at 38 weeks gestation, uncomplicated. Immediate postnatal observation revealed a bulging parietal-occipital scalp mass with venous dilation. Admission to neonatal intensive care unit for monitoring and ventilatory support. Initiation of mechanical ventilation with pressure support and FiO₂ titration. MRI confirmed the presence and extent of the scalp hemangioma, guiding further management decisions [Figure 2 ]. This timeline reflects the sequence of events from birth to initial diagnostic evaluation and the institution of supportive care, establishing a foundation for ongoing monitoring and management of the hemangioma. Discussion This case contributes to the limited body of literature on the prenatal detection of cranial hemangiomas by presenting a rare example of a rapidly involuting congenital hemangioma (RICH) identified in the third trimester of pregnancy. Prenatal recognition of such lesions is uncommon, as most infantile hemangiomas manifest postnatally, typically after the second week of life. Our findings align with previous reports indicating that hemangiomas identifiable in utero generally appear after 26 weeks of gestation ( 5 ). The most common benign vascular neoplasms in children, occurring in approximately 4–5% of Caucasian populations, are driven by proliferation of endothelial-like cells ( 5 ). The pathogenesis of cranial hemangiomas may involve hemangiomatous disruption of developing hair follicles or represent a hamartomatous growth pattern ( 6 ). Historically, the earliest descriptions of intradiploic vascular tumors date back to 1845, when Toynbee documented a lesion confined within the parietal bone ( 7 ). Subsequent reports have indicated that the temporal bone is most frequently involved, followed by the parietal and, less commonly, occipital bones ( 7 ). In our case, the lesion was located in the parietal-occipital region, consistent with these observations. The initial clinical assessment revealed a prominent bulging mass with visible venous dilations and patent cranial sutures. Both anterior and posterior fontanelles appeared normal, providing reassurance regarding intracranial pressure and overall cranial integrity. A major strength of this case lies in the detailed prenatal and postnatal documentation, including imaging studies that allowed precise localization and characterization of the hemangioma. This comprehensive evaluation supports timely monitoring and facilitates informed decisions regarding intervention. However, the case has limitations, including the absence of prenatal ultrasonography that might have detected the lesion earlier and the lack of Apgar scores due to home delivery, which restricts complete assessment of immediate postnatal adaptation. Additionally, long-term follow-up data are limited, preventing evaluation of eventual involution or functional outcomes. The clinical course of this neonate supports existing evidence that early identification and careful monitoring of cranial hemangiomas are crucial for preventing complications and guiding intervention. Notably, the introduction of propranolol therapy for infantile hemangiomas has transformed management strategies. In landmark studies, systemic propranolol effectively reduced hemangioma size and vascularity, even in infants with comorbid conditions ( 8 ). While our patient did not receive systemic therapy, the case emphasizes the importance of individualized management plans that consider lesion size, location, and potential impact on surrounding structures. CONCLUSION In this case underscores the significance of meticulous prenatal and postnatal evaluation of congenital cranial hemangiomas. It highlights the need for interdisciplinary coordination between neonatology, radiology, and pediatric surgery to optimize outcomes. The etiology likely involves endothelial proliferation and localized tissue disruption, consistent with previously reported mechanisms, while the rarity of prenatal detection makes each case valuable for expanding clinical understanding and informing best practices. Declarations Data Sharing Statement We confirm that we have complete access to all data in this study and accept full responsibility for its integrity. Data for this study are available upon reasonable request from the corresponding author. Ethics approval : In accordance with the regulations of the review board at Mogadishu Somali Turkish Training and Research Hospital, institutional review board approval is not necessary for case reports. Consent for Publication: Written informed consent was obtained from the patient father to publish the case details and any associated images. Conflict of Interest: The authors have disclosed any financial or personal relationships with individuals or organizations that could bias their work. There are no undisclosed conflicts of interest. Competing interests: We declare that we have no competing interests. Clinical trial number not applicable. Funding: We declare that we have no funding source. Author Contribution All listed authors fulfil the authorship criteria specified by the journal, having significantly contributed to the conception, design, execution, or interpretation of the study. We have approved the submitted version and accept responsibility for all aspects of the work. Acknowledgements: All those who have significantly contributed to the work detailed in the manuscript but do not fit the requirements for authorship have been acknowledged by the authors. Data Availability We confirm that we have complete access to all data in this study and accept full responsibility for its integrity. Data for this study are available upon reasonable request from the corresponding author. References Korekawa A, Nakajima K, Nakano H, Sawamura D. Benign neonatal hemangiomatosis with early regression of skin lesions: A case report and review of the published work. J Dermatol. 2020;47(8):911–6. Gullabzada M, Brito Y, Gonzalez AI, Zena D, Jabri MN. Infantile Hemangioma in Infancy: A Case Study on the Natural Course and Therapeutic Management. Cureus [Internet]. 2024 Jun 25 [cited 2024 Dec 10]; Available from: https://www.cureus.com/articles/260882-infantile-hemangioma-in-infancy-a-case-study-on-the-natural-course-and-therapeutic-management Debbaneh PM, Zou Y, Zim S. Pediatric Subcutaneous Scalp Mass: A Case Report and Review. Perm J. 2022;26(2):149–52. Hu Y, Dong H. Rare Presentation of Rapidly Involuting Congenital Hemangioma of the Skull: A Case Report. Am J Case Rep [Internet]. 2024 Mar 17 [cited 2024 Dec 10];25. Available from: https://www.amjcaserep.com/abstract/index/idArt/943370 Bleve C, Conighi ML, Valerio E, Cutrone M, Iannucci G, Segna A et al. Surgical management of large scalp infantile hemangioma in 30-month-old infant. Pediatr Med Chir [Internet]. 2022 Mar 21 [cited 2024 Dec 10];44(1). Available from: http://www.pediatrmedchir.org/index.php/pmc/article/view/279 Pastukhova E, Kanigsberg N. Segmental infantile hemangioma with milia: A case report. SAGE Open Med Case Rep. 2023;11:2050313X231164265. Karachi LNH, Tariq P. A. Intraosseous cavernous hemangioma of parietal bone: A case report and literature review. J Clin Images Med Case Rep [Internet]. 2024 Mar 13 [cited 2024 Dec 10];5(3). Available from: https://jcimcr.org/articles/JCIMCR-V5-2920.html Sandru F, Petca A, Radu AM, Preda AG, Turenschi A, Constantin AT, et al. Infantile Hemangioma: Risk Factors and Management in a Preterm Patient—A Case Report. Y Rep. 2024;7(1):3. Additional Declarations No competing interests reported. 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1","display":"","copyAsset":false,"role":"figure","size":366785,"visible":true,"origin":"","legend":"\u003cp\u003eCT scan:(A) large exophytic, hyperattenuating mass lesion measuring approximately 95 x 53 mm in the extracranial region at the vertex level. (B)The lesion exhibits central calcifications(black arrow) and areas of hypodensity, suggesting necrosis. (C) mass has caused significant remodeling of the parietal bone, with marked thinning and bone defects, although no evidence of intracranial extension but has linking of superior sagittal sinus(blue arrow) extending into the mass.the lesion has vascular structures peripherally(orange arrow).\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8233462/v1/721dc6787bc6cfb46ee779d3.png"},{"id":97434769,"identity":"6117a4bc-5bac-48d5-a0db-fe777d9f1da3","added_by":"auto","created_at":"2025-12-04 10:55:27","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":460405,"visible":true,"origin":"","legend":"\u003cp\u003eA giant, avidly enhancing soft tissue mass measuring 8.7 x 4.6 x 5.3 cm was identified in the biparietal vertex region. The lesion demonstrates extensive vascularity with venous drainage into the superior sagittal sinus (SSS).\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8233462/v1/6b8b4d60c5104a76e3d42219.jpeg"},{"id":99790625,"identity":"fc10346b-4383-4322-b644-d59933148564","added_by":"auto","created_at":"2026-01-08 12:58:26","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1330312,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8233462/v1/3ca3d260-5523-469a-bb34-ac04f9f924de.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Giant Scalp Hemangioma in a Term Neonate: Diagnostic Challenges and Imaging Insights – A Case Report","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eBenign newborn hemangiomatosis (BNH) is an uncommon, non-heritable, and self-limiting condition, characterized by multiple cutaneous infantile hemangiomas (IH) with minimal or absent visceral involvement (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). These lesions typically appear between the second and eighth week of life and can be either congenital (approximately 30% of cases) or infantile in origin (around 70%) (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). While most infantile hemangiomas are identified postnatally, prenatal detection remains rare due to their late gestational emergence and subtle imaging characteristics (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). All infantile hemangiomas exhibit GLUT1 positivity on immunohistochemistry, a distinctive feature that differentiates them from other vascular tumors (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThis case is unique because it presents a rapidly involuting congenital hemangioma (RICH) located on the scalp, which was identified during the third trimester of pregnancy. Prenatal recognition of cranial hemangiomas is exceedingly rare, and such early detection allows for anticipatory planning, close postnatal monitoring, and timely multidisciplinary management. By documenting this case, we aim to contribute to the limited literature on prenatal cranial hemangiomas and emphasize the clinical and imaging features that can guide appropriate management in similar neonatal presentations.\u003c/p\u003e"},{"header":"CASE PRESENTATION","content":"\u003cp\u003eA male neonate, born at 38 weeks of gestation via normal spontaneous vaginal delivery to a 30-year-old gravida 8, para 6 mother, presented with a prominent parietal-occipital scalp mass. The mother had no pre-existing medical conditions, and the pregnancy was uncomplicated. Prenatal laboratory tests and fetal ultrasonography were unremarkable. There was no family history of vascular anomalies or congenital malformations. Apgar scores were undocumented due to delivery at home. The patient had no known psychosocial risk factors and was living in a supportive home environment.\u003c/p\u003e\u003cp\u003eThe primary concern upon presentation was the rapidly enlarging scalp mass with visible venous dilations, associated with mild respiratory compromise requiring ventilatory support. The infant exhibited no other acute symptoms such as feeding difficulties, cyanosis, or neurological deficits at the time of admission.\u003c/p\u003e\u003cp\u003eOn examination, the neonate appeared hemodynamically stable but required respiratory support via pressure support spontaneous mode, with a peak inspiratory pressure of 18 cm H₂O, PEEP of 6 cm H₂O, inspiratory time of 0.40 seconds, and FiO₂ of 40%, maintaining oxygen saturation between 92% and 93%. The scalp lesion measured [Figure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e], was soft, compressible, and non-tender, with prominent venous markings. Cranial sutures were widely patent, and both fontanelles were normal. Cardiovascular, respiratory, and abdominal examinations were unremarkable. Neurological assessment was appropriate for gestational age. Relevant interventions prior to presentation included supportive care at home; no previous surgical or pharmacological interventions had been administered. Following admission, mechanical ventilation was initiated to maintain adequate oxygenation. Imaging studies, including MRI, confirmed a large parietal-occipital scalp hemangioma.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe clinical course can be summarized as follows:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eBirth at home at 38 weeks gestation, uncomplicated.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eImmediate postnatal observation revealed a bulging parietal-occipital scalp mass with venous dilation.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eAdmission to neonatal intensive care unit for monitoring and ventilatory support.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eInitiation of mechanical ventilation with pressure support and FiO₂ titration.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eMRI confirmed the presence and extent of the scalp hemangioma, guiding further management decisions [Figure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThis timeline reflects the sequence of events from birth to initial diagnostic evaluation and the institution of supportive care, establishing a foundation for ongoing monitoring and management of the hemangioma.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis case contributes to the limited body of literature on the prenatal detection of cranial hemangiomas by presenting a rare example of a rapidly involuting congenital hemangioma (RICH) identified in the third trimester of pregnancy. Prenatal recognition of such lesions is uncommon, as most infantile hemangiomas manifest postnatally, typically after the second week of life. Our findings align with previous reports indicating that hemangiomas identifiable in utero generally appear after 26 weeks of gestation (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). The most common benign vascular neoplasms in children, occurring in approximately 4\u0026ndash;5% of Caucasian populations, are driven by proliferation of endothelial-like cells (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). The pathogenesis of cranial hemangiomas may involve hemangiomatous disruption of developing hair follicles or represent a hamartomatous growth pattern (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eHistorically, the earliest descriptions of intradiploic vascular tumors date back to 1845, when Toynbee documented a lesion confined within the parietal bone (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Subsequent reports have indicated that the temporal bone is most frequently involved, followed by the parietal and, less commonly, occipital bones (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). In our case, the lesion was located in the parietal-occipital region, consistent with these observations. The initial clinical assessment revealed a prominent bulging mass with visible venous dilations and patent cranial sutures. Both anterior and posterior fontanelles appeared normal, providing reassurance regarding intracranial pressure and overall cranial integrity.\u003c/p\u003e\u003cp\u003eA major strength of this case lies in the detailed prenatal and postnatal documentation, including imaging studies that allowed precise localization and characterization of the hemangioma. This comprehensive evaluation supports timely monitoring and facilitates informed decisions regarding intervention. However, the case has limitations, including the absence of prenatal ultrasonography that might have detected the lesion earlier and the lack of Apgar scores due to home delivery, which restricts complete assessment of immediate postnatal adaptation. Additionally, long-term follow-up data are limited, preventing evaluation of eventual involution or functional outcomes.\u003c/p\u003e\u003cp\u003eThe clinical course of this neonate supports existing evidence that early identification and careful monitoring of cranial hemangiomas are crucial for preventing complications and guiding intervention. Notably, the introduction of propranolol therapy for infantile hemangiomas has transformed management strategies. In landmark studies, systemic propranolol effectively reduced hemangioma size and vascularity, even in infants with comorbid conditions (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). While our patient did not receive systemic therapy, the case emphasizes the importance of individualized management plans that consider lesion size, location, and potential impact on surrounding structures.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eIn this case underscores the significance of meticulous prenatal and postnatal evaluation of congenital cranial hemangiomas. It highlights the need for interdisciplinary coordination between neonatology, radiology, and pediatric surgery to optimize outcomes. The etiology likely involves endothelial proliferation and localized tissue disruption, consistent with previously reported mechanisms, while the rarity of prenatal detection makes each case valuable for expanding clinical understanding and informing best practices.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eData Sharing Statement\u003c/strong\u003e\u003cp\u003eWe confirm that we have complete access to all data in this study and accept full responsibility for its integrity. Data for this study are available upon reasonable request from the corresponding author.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003e\u003cb\u003eEthics approval\u003c/b\u003e:\u003c/strong\u003e\u003cp\u003eIn accordance with the regulations of the review board at Mogadishu Somali Turkish Training and Research Hospital, institutional review board approval is not necessary for case reports.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent for Publication:\u003c/strong\u003e\u003cp\u003eWritten informed consent was obtained from the patient father to publish the case details and any associated images.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConflict of Interest:\u003c/strong\u003e\u003cp\u003eThe authors have disclosed any financial or personal relationships with individuals or organizations that could bias their work. There are no undisclosed conflicts of interest.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eCompeting interests:\u003c/h2\u003e\u003cp\u003eWe declare that we have no competing interests.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003cp\u003enot applicable.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e\u003cp\u003eWe declare that we have no funding source.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAll listed authors fulfil the authorship criteria specified by the journal, having significantly contributed to the conception, design, execution, or interpretation of the study. We have approved the submitted version and accept responsibility for all aspects of the work.\u003c/p\u003e\u003ch2\u003eAcknowledgements:\u003c/h2\u003e\u003cp\u003eAll those who have significantly contributed to the work detailed in the manuscript but do not fit the requirements for authorship have been acknowledged by the authors.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eWe confirm that we have complete access to all data in this study and accept full responsibility for its integrity. Data for this study are available upon reasonable request from the corresponding author.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKorekawa A, Nakajima K, Nakano H, Sawamura D. Benign neonatal hemangiomatosis with early regression of skin lesions: A case report and review of the published work. J Dermatol. 2020;47(8):911\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGullabzada M, Brito Y, Gonzalez AI, Zena D, Jabri MN. Infantile Hemangioma in Infancy: A Case Study on the Natural Course and Therapeutic Management. Cureus [Internet]. 2024 Jun 25 [cited 2024 Dec 10]; Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.cureus.com/articles/260882-infantile-hemangioma-in-infancy-a-case-study-on-the-natural-course-and-therapeutic-management\u003c/span\u003e\u003cspan address=\"https://www.cureus.com/articles/260882-infantile-hemangioma-in-infancy-a-case-study-on-the-natural-course-and-therapeutic-management\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDebbaneh PM, Zou Y, Zim S. Pediatric Subcutaneous Scalp Mass: A Case Report and Review. Perm J. 2022;26(2):149\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHu Y, Dong H. Rare Presentation of Rapidly Involuting Congenital Hemangioma of the Skull: A Case Report. Am J Case Rep [Internet]. 2024 Mar 17 [cited 2024 Dec 10];25. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.amjcaserep.com/abstract/index/idArt/943370\u003c/span\u003e\u003cspan address=\"https://www.amjcaserep.com/abstract/index/idArt/943370\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBleve C, Conighi ML, Valerio E, Cutrone M, Iannucci G, Segna A et al. Surgical management of large scalp infantile hemangioma in 30-month-old infant. Pediatr Med Chir [Internet]. 2022 Mar 21 [cited 2024 Dec 10];44(1). Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.pediatrmedchir.org/index.php/pmc/article/view/279\u003c/span\u003e\u003cspan address=\"http://www.pediatrmedchir.org/index.php/pmc/article/view/279\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePastukhova E, Kanigsberg N. Segmental infantile hemangioma with milia: A case report. SAGE Open Med Case Rep. 2023;11:2050313X231164265.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKarachi LNH, Tariq P. A. Intraosseous cavernous hemangioma of parietal bone: A case report and literature review. J Clin Images Med Case Rep [Internet]. 2024 Mar 13 [cited 2024 Dec 10];5(3). Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://jcimcr.org/articles/JCIMCR-V5-2920.html\u003c/span\u003e\u003cspan address=\"https://jcimcr.org/articles/JCIMCR-V5-2920.html\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSandru F, Petca A, Radu AM, Preda AG, Turenschi A, Constantin AT, et al. Infantile Hemangioma: Risk Factors and Management in a Preterm Patient\u0026mdash;A Case Report. Y Rep. 2024;7(1):3.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Neonatal hemangioma, benign newborn hemangiomatosis (BNH), rapidly involuting congenital hemangioma (RICH), cranial hemangioma, vascular anomalies, prenatal detection, interdisciplinary management","lastPublishedDoi":"10.21203/rs.3.rs-8233462/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8233462/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eIntroduction: Benign newborn hemangiomatosis (BNH) is a rare, non-heritable, and typically self-resolving condition, characterized by multiple cutaneous neonatal hemangiomas (IH) with few or no visceral lesions. These lesions generally manifest between the second and eighth week of life and may be congenital (30%) or, more frequently, infantile (70%).\u003c/p\u003e\u003cp\u003eCase Presentation: A male neonate, born at 38 weeks of gestation via spontaneous vaginal delivery to a 30-year-old gravida 8, para 6 woman with no prior medical history, presented with multiple cutaneous lesions. The pregnancy was uncomplicated, with normal prenatal laboratory findings and unremarkable fetal survey. Apgar scores were not documented due to the home birth setting.\u003c/p\u003e\u003cp\u003eDiscussion: This report contributes to the limited literature on prenatal detection of cranial hemangiomas by presenting a rare case of a rapidly involuting congenital hemangioma (RICH) identified in the third trimester. Although such prenatal diagnoses are uncommon, our findings align with prior reports indicating that in utero detectable hemangiomas generally appear after 26 weeks of gestation. Infantile hemangiomas, the most common benign vascular neoplasms in children, affect up to 4\u0026ndash;5% of Caucasian infants and result from proliferation of endothelial-like cells. In this case, the lesions may reflect hemangiomatous disruption of developing hair follicles or represent a hamartomatous formation.\u003c/p\u003e\u003cp\u003eConclusion: Close monitoring and follow-up imaging during the first year of life are essential to assess lesion progression and involution. Recognizing the distinctive clinical and imaging features of cranial hemangiomas is critical to avoid unnecessary interventions and to implement appropriate management. This case underscores the importance of interdisciplinary collaboration in the care of neonates with vascular anomalies.\u003c/p\u003e","manuscriptTitle":"Giant Scalp Hemangioma in a Term Neonate: Diagnostic Challenges and Imaging Insights – A Case Report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-04 10:55:22","doi":"10.21203/rs.3.rs-8233462/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b1258b22-c0ba-484a-b556-e27e7bf296ba","owner":[],"postedDate":"December 4th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-05T05:24:13+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-04 10:55:22","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8233462","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8233462","identity":"rs-8233462","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}