Faced with PHACES: A photo series of its progression and overview of clinical management

Abstract

Introduction: Posterior fossa anomalies, hemangioma, arterial anomalies, cardiac anomalies, eye anomalies, and sternal anomalies (PHACES) syndrome is a rare, multi-system disorder. Case Report: We illustrate a case of a 1-month-old female who presented emergently with an enlarging, large, left-sided hemangioma segmentally distributed over the ophthalmic branch of the trigeminal nerve (V1) region prompting clinical concern for PHACES syndrome. Further workup was recommended to evaluate for extracutaneous involvement, which subsequently revealed coarctation of the aorta and multiple arterial abnormalities. Conclusion: The vast array of potential, devastating complications linked to PHACES syndrome highlights the importance of prompt identification when confronted with hemangiomas, especially in the pediatric population. We further present a photo series demonstrating the evolution of our patient’s infantile hemangioma from its subtle initial stages through its rapid evolution leading to her emergent presentation, emphasizing the importance of early clinical suspicion and intervention.