Aim To review the outcomes of investigations for midline infantile haemangiomas (IH) overlying the head or spine in a tertiary paediatric dermatology department.

Methods Case notes and radiological results were reviewed retrospectively for all patients with a clinical diagnosis of HI overlying the midline of the scalp, neck or spine seen over the 5 year period October 2009–14.

Results 43 patients were identified (31 girls). The median age at the first specialist clinic appointment was 5 months (range 2–23 months). In 26 patients the IH were located on the scalp, in five on the back of the neck, in four overlying the thoracic spine and in eight overlying the lumbar spine and or sacrum. 24 lesions were more than 5 cm and 19 less than 5 cm in size at the time of the first appointment, 10 of which were plaque-type IH. 18/43 patients had MRI of either the brain or spine following the initial assessment. MRI was normal in 15 patients, including in all lumbosacral lesions. In two cases of plaque-type IH a diagnosis of PHACES syndrome was confirmed. In one child where the IH was a palm-sized lesion over the thoracic spine, MRI showed extension of the IH into the spinal canal, with complete compression of the cord between T4 and T9. The child was neurologically asymptomatic at the first assessment, but the result prompted treatment with propranolol.

Conclusion This retrospective series of midline IH seen over a five year period in a tertiary centre has identified a significant underlying lesion in a child with a thoracic spinal IH. The current literature from experts in the field recommends MRI for lumbosacral lesions. Our internal guidelines will now dictate an MRI of the underlying CNS in all infants with a midline IH on the scalp, neck or spine.