Hadi Fakih, Hussein A. Hussein, Fatima Fakih
Sheikh Ragheb Harb University Hospital. Lebanese University.
Lebanon
Cureus
Cureus 2026; 18:
DOI: 10.7759/cureus.109082
Abstract
Vein of Galen malformation (VoGM) is a rare congenital vascular anomaly. It represents a well-recognized extracardiac cause of high-output cardiac failure in the neonatal period. We report a case of a 3.5-month-old boy who presented for routine vaccination and was incidentally found to have macrocephaly (head circumference 44.5 cm, >99th percentile) with early sun-setting eyes. He was otherwise well-appearing with a normal neurological examination. Bedside cranial ultrasound revealed bilateral lateral and third ventricular dilation with a cystic mass compressing the aqueduct, and brain MRI confirmed a dilated cystic malformation of the vein of Galen as the cause of obstructive hydrocephalus. His past medical history was significant for severe neonatal respiratory distress complicated by pulmonary hypertension and congestive heart failure, initially attributed to neonatal pneumonia. This case highlights that VoGM should be considered in the differential diagnosis of neonatal persistent pulmonary hypertension (PPHN) and high-output heart failure, even when a concurrent respiratory illness is present, and emphasizes the value of bedside cranial Doppler ultrasound and thorough physical examination including fontanel auscultation.
Category
Class I. Pulmonary Hypertension Associated with Congenital Cardiovascular Disease
Symptoms and Findings Associated with Pulmonary Vascular Disease
Age Focus: Pediatric Pulmonary Vascular Disease
Fresh or Filed Publication: Fresh (PHresh). Less than 1-2 years since publication
Article Access
Free PDF File or Full Text Article Available Through PubMed or DOI: Yes