Erythematous macule that changes with crying: a case of sinus pericranii

Sinus pericranii is a rare venous malformation characterized by an abnormal communication between the intracranial and extracranial venous systems. It typically presents as a painless, compressible, non-pulsatile lesion that may increase in size with maneuvers that increase venous pressure.

We report the case of a 12-month-old infant with a congenital interglabellar erythematous macule whose volume increased 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, leading to diagnosis of sinus pericranii. Given the asymptomatic nature of the lesion, we opted for conservative management with clinical and radiological follow-up.

The differential diagnosis includes other vascular malformations that are more common, such as venous malformations, nevus simplex, and port-wine stain, as well as infantile hemangioma and arteriovenous malformations. The management of these lesions 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.