Prenatal diagnosis of concurrent facial and cerebral vascular malformation which caused congestive heart failure

Arteriovenous malformations (AVMs) are rarely reported antenatally. Most in utero diagnosis of vascular malformation is related to vein of Galen malformation (VGM). We describe a case of simultaneously diagnosed pial arteriovenous fistula (AVF) and facial vascular malformation in a 20 weeks old fetus. The dilated intracranial venous pouch appeared as a midline anechoic structure which was misdiagnosed as a VGM in her previous ultrasound exam. Another AVM was diagnosed in the same side of fetal face which fed by a branch of external carotid artery and communicated with the mentioned pial AVF. High output cardiac failure and hydrops were evident. To our knowledge this is the first report of prenatally detected combination of facial and cerebral vascular malformations at such as early pregnancy week.