Skeletal Radiol (2005) 34:485–489 DOI 10.1007/s00256-004-0891-6 CASE REPORT George Koulouris Padma Rao Multiple congenital cranial hemangiomas Received: 13 July 2004 Revised: 29 November 2004 Accepted: 1 December 2004 Published online: 19 February 2005 # ISS 2005 G. Koulouris ( ) ) Department of Radiology, The Alfred Hospital, Commercial Road, 3181 Prahran, Victoria, Australia e-mail: drgeorgek@mbox.com.au Tel.: +61-3-92762118 Fax: +61-3-92762988 P. Rao Department of Radiology, Royal Children’s Hospital, Flemington Road, 3052 Parkville, Victoria, Australia Abstract Though cranial heman- giomas are second only to vertebral hemangiomas in frequency, such le- sions are rarely congenital and mul- tiple. It is probable that the true in- cidence of congenital calvarial he- mangiomas is higher than that re- ported in the literature, as they are unlikely to undergo imaging, most being asymptomatic and without a significant soft tissue component. We present a case of multiple congenital calvarial and skull base cavernous- type hemangiomas, diagnosed in a 4- day-old female, involving the right zygoma, maxilla, frontal and petrous temporal bones and contralateral squamous temporal bone. Surgical biopsy confirmed the radiological diagnosis as well as the concomitant multiple subcutaneous capillary-type hemangiomas which were identified clinically. No specific clinical syn- drome or chromosomal abnormality was identified and the underlying cerebral parenchyma was normal with no intra-axial involvement. With conservative treatment, two lesions completely resolved and a further two lesions subsequently decreased in both size and degree of enhancement. To the best of our knowledge, this is the first case of multiple congenital hemangiomas involving the calvari- um and skull base. Despite this, the radiological features, combined with the clinical findings of multiple cap- illary hemangiomas, were character- istic enough to permit an accurate preoperative diagnosis. Osseous he- mangiomas should feature promi- nently in any differential diagnosis of multiple hypervascular lesions, as they are common, more so when limited to an anatomical region, ir- respective of site or age. Keywords Cranial · Calvarium · Hemangioma · Magnetic resonance (MR) · Computed tomography (CT) · Technetium (Tc) Introduction Osseous hemangiomas account for 1% of all primary bone neoplasms, with involvement of the vertebral col- umn the most frequent location followed by the cranium, the two sites accounting for roughly 75% of all skeletal hemangiomas [1]. Unlike hemangiomas affecting the appendicular skeleton, involvement of the vertebral col- umn and calvarium is usually asymptomatic [1] and an incidental radiological finding. Hemangiomas of the cal- varium constitute 10% of benign neoplasms of this region and overall make up approximately 0.2% of all bone tu- mors [2]. The most frequently involved site in the cal- varium is the frontal bone [3]. Cavernous hemangioma, the most common sub-type of osseous hemangioma [1], has been reported as a solitary lesion in the skull of a neonate [4]. Even in the adult setting, multiple cranial bone involvement is exceedingly rare [3, 5, 6, 7]. Despite being the most common soft tissue tumor of infancy and childhood, the osseous form of hemangioma is rarely described in children. Congenital lesions are even rarer. To the best of our knowledge, this is the first reported