Erythematous macule changing with crying: a case of sinus pericranii

Abstract

Sinus pericranii is a rare venous malformation characterized by an abnormal communication between the intracranial and extracranial venous systems. Clinically, it typically presents as a painless, compressible, non-pulsatile lesion that may increase in size with maneuvers that raise venous pressure. We report the case of a 12-month-old infant with an interglabellar erythematous macule present since birth, which showed an increase in volume during crying. Doppler ultrasound revealed an underlying vascular structure with volume changes during crying. Contrast-enhanced magnetic resonance imaging confirmed a venous connection between the extracranial vascular lesion and the intracranial circulation, establishing the diagnosis of sinus pericranii. Given the asymptomatic nature of the lesion, conservative management with clinical and radiological follow-up was chosen. The differential diagnosis includes other more common vascular malformations, such as venous malformations, nevus simplex, and port-wine stain, as well as infantile hemangiomas and arteriovenous malformations. Management of this entity remains controversial, ranging from observation to early intervention depending on the risk of complications and aesthetic considerations. Finally, we emphasize the importance of recognizing lesion enlargement during crying as a key clinical sign to raise suspicion for this condition and guide appropriate diagnosis.