Presentation
Subcutaneous scalp mass.
Patient Data
Subcutaneous mass on the left side of the scalp showing multiple serpiginous flow voids within the lesion, in keeping with dilated vessels.
A well-defined arteriovenous malformation (AVM) is observed between the right external jugular vein and the terminal branches of the right external carotid artery (ECA), likely originating from the maxillary artery.
The AVM has caused dilation of the external jugular vein with early filling, along with multiple dilated draining veins in the facial, superficial temporal, and maxillary regions, particularly noticeable on the left side, though some dilation is also present on the right.
No evidence of intracranial communication or extension of the AVM into the brain is noted.
Internal carotid arteries (ICA) and their intracranial branches appear normal.
The remaining intracranial vasculature is unremarkable.
Case Discussion
Scalp arteriovenous malformations (AVMs) are rare extracranial vascular anomalies that typically present with enlarging, pulsatile masses, often accompanied by headaches or other symptoms like tinnitus. These malformations result from an abnormal connection between arterial feeders and draining veins without an intermediary capillary bed, leading to increased venous dilation and possible cosmetic or functional complications.
The management of scalp AVMs can vary, with options including endovascular embolization or surgical excision. While embolization is effective in small-sized AVMs, as in the present case, larger or more complex malformations often require surgical intervention. Recent literature suggests the necessity of cerebral angiography to precisely map the vascular architecture and guide treatment.
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