A Neonatal Case of Hemorrhagic Shock Due to Congenital Hemangioma

Congenital hemangioma (CH) is a rare form of vascular anomaly that develops prenatally, is difficult to differentiate from other vascular anomalies, and poses significant risks, including heart failure and severe hemorrhage. Herein, we present the case of a female infant born with a dark red mass measuring 30 mm × 20 mm in size, located on the right temporal region. She was referred to us for outpatient follow-up but presented to the emergency department on day 21 of life with a massive pulsatile hemorrhage originating from the mass. The patient simultaneously presented with tachycardia and cold extremities. We initiated artificial respiration and compression of the vascular anomalies, and the bleeding was well-controlled. Red blood cell transfusion stabilized her circulation, allowing transfer of the patient to Iwate Medical University Hospital for further evaluation. Owing to difficulties in differentiating CH from other vascular anomalies on imaging, a biopsy was performed. Histological examination revealed a dilated vascular cavity, lined with a single layer of endothelial-like cells with no arterial components. Although hemorrhage from rapidly involutingCH is rare, it is possible that ulceration of the CH could induce hemorrhage.