 Hello everyone. I'm presenting a case report on Cripple-Haranoi syndrome with persistent sciatic pain. First case history, a four-month-old female baby developed diffuse swelling in the left gluteal relation after one month of age. The infant developed pain over the region one month ago and was diagnosed as absc language, incision and drainage was done at an outside hospital. Further, fever with progressive increase in size of the right vertech, and swelling and redness over the right lacrimate manualus was noticed in the last week for which the infant was brought to a hospital. Antinatal and postnatal history was nil significant and no significant family history was there. And on examination, port wine stains over the gluteal, left and right gluteal region was noticed. Diffuse swelling involving the lower outer and inner quadrants of bilateral gluteal region was also noticed. Systemic examination was unremarkable. Further, the blood investigation is revealed features of sepsis with anemia. Neutrophilia and thrombocytopenia also were observed. So on examination, local examination, these are the diagrams depicting port wine stains in the gluteal cleft and right gluteal region. In the second image, swelling of bilateral gluteal region can be seen. And the third image is the image depicting normal bilateral lower limbs with no limb length discrepancies or soft tissue swelling or hypertrophy of the lower limbs. So as the initial investigation, ultrasound with Doppler evaluation was done of bilateral gluteal region that showed diffuse thickening of subcutaneous plane with multiple small cystic nations within the hypertrophy or thickened subcutaneous tissue. With no color update. And on color Doppler evaluation, a torches tubular structure could be seen in the inter muscular plane in post-lateral aspect of right inferior gluteal region. And the torches venous structure was showing good color update compressibility and venous spectrum pattern. The structure was seen to be extending till the upper half of the inter muscular plane. And the possibility of the vein causing adjacent to the sciatic nerve was also considered. So with the ultrasound and the Doppler color Doppler findings, the possible diagnosis of a lymphatic malformation with an associated vascular malformation was considered and MRI was further suggested for further evaluation. So MRI with contrast of bilateral gluteal region and bilateral lower limbs was taken and in the presence light we are seeing axial images of the gluteal region in T1, T2, fat set and post contrast sequences showing diffuse hypertrophy of bilateral gluteal region, a subcutaneous tissue with which is appearing heterogeneously hyper intense in T2 and still sequence and showing heterogeneous post contrast enhancement in post contrast sequence. Also, within the hypertrophied subcutaneous tissue multiple small stick areas could be seen, which is showing fluid signal intensity. So these features were suggestive of a lymphatic malformation likely a microcystic lymph node. In the next slide, we are seeing axial images of the pelvis showing a tubular hyper intense structure along the course of right sciatic nerve that is seen passing through the inter muscular plane and through the sciatic foramen. We are seeing entering the pelvis and then draining into the right internal area and in the post contrast image, post contrast enhancement of the tubular structure was also observed. So these features were suggestive of a persistent sciatic pain. In this slide, the still sequence and post contrast sequence depicts the dilative torches lateral marginal vein and the dilative torches short subcutaneous vein. Diagnosis. A five month old infant presented the port wine stain since welling in the gluteal region. The ideological evaluation revealed features of microcystic lymph angioma with persistent sciatic vein and dilative lateral marginal vein and short subcutaneous vein. On the basis of the above findings, the diagnosis of clippel trinois syndrome was made. The infant was managed with IV antibiotics in view of sepsis and then the later later the infant underwent liposuction of bilateral gluteal region where lymph and fatty tissue was obtained. Further, regular follow-ups were advised on discharge. Moving on to discussion, clippel trinois syndrome is a rare congenital disorder with an incidence of one in one lakh people worldwide. It was first described by two physicians in 1900 that is clippen and trinoi after home it was named. It is characterized by vascular malformations that is capillary venous hermaphytic and bone or soft tissue hypertrophy. Any of the two features are enough to diagnose clippel trinois syndrome. It occurs sporadically and has no sex predilection and usually manifests at birth or childhood. Unilateral lower extremity is the most common site involved and the cutaneous capillary malformations can be in the form of both wine stains with limb or soft tissue hypertrophy. Venous malformations may involve both superficial and deep venous system. Superficial venous malformations include varicositis, persistent embryonic veins and deep venous malformations are in the form of hyperplasia, segmental eclasia or aneurysmal degeneration. The lymphatic deformities include primary lymphedema, cystic hygroma, lymphectasia, it can be microcystic macrosystem or mixed, which can lead to lymphatic insufficiency, congestion or lymphuria. Visceral vascular malformations can also develop and the various systemic organs involved include brain, cardiovascular system, gastro-industrial system or genitourinary system. Common complications seen are thrombosis of the vessels in the extremities, recurrent pulmonary emboli, lymphedema, hemorrhage secondary to vascular malformations. The etiology is still unknown but it has been hypothesized that it could be caused by a mesodermal abnormality during fetal development. Persistent embryonic veins are characteristic for triple trininois syndrome in which the lateral marginal vein and persistent sciatic vein are more common and usually they should rigorous before birth. The lateral marginal vein is a superficial vein whereas the persistent sciatic vein is part of a deep venous system. During embryonic life, the large primitive axial vein drains the lower extremity. When there is persistence of this axial vein which normally should repress, it is defined as the persistent sciatic vein. The persistent sciatic vein has found in three morphological forms, complete, when the persistent sciatic vein arises from the plitil vein, the absence to traverse the sciatic notch and terminates draining into the internal endothelium, upper persistent sciatic vein arises from the minor tributaries of upper thigh and passes through sciatic notch to end in pelvis. And lower PSP is seen in the distant and middle third of thigh and opens into deep femoral veins. Moving on to imaging modalities, serial scanograms, computer tomograms or other standard radiographs, radiographic studies can be done to assess limb length discrepancies. Ascending and descending menography is useful for assessing the anatomy of the deep veins including embryology veins and their connection to deep venous system. Dr. Al-Rasun was usually the first imaging modality used for differentiating vascular tumors and vascular malformation and to assess these malformations. CT and MRA are beneficial for visualizing the extent of these lesions, hypertrophy of the muscles or bone or presence of the malformations and the abdomen and pelvic involvement of these malformations. Prenatal diagnosis of KTS by Al-Rasun and MRA has also been described in various articles and scendography may be utilized to assess the region of the bone and bone mass chromatic. Moving on to the management, non-operative medical management is the main modality for treatment of symptomatic KTS patients. Length discrepancies are usually managed with heel inserts or compensated tissues. However, if there is discrepancy of more than two centimeters surgical intervention should be considered. Sclerotherapy or embolization are considered for bad atrocities not responding to medical management, but patency of the deep venous system should be confirmed before any intervention. Persistent sciatic vein is treated usually with sclerotherapy or embolization or endovascular radiofrequency amylation is another option that is coming up in these days. These are my references that I have used in this paper presentation. Thank you.