An 9-year old previously healthy female presented for her regular annual well visit to her pediatrician, who noted a round, raised pulsating area over her right clavicular region (Fig 6).  Her parents report that they noticed this about 3-4 months ago, and she denied pain, bleeding, or trauma to the area.  She does endorse intermittent headaches of varying severity, occurring every 2 weeks, and not associated with visual changes. Acetaminophen and rest provide relief for the more severe headaches. Of note, there is no other medical history or family history of vascular issues or epistaxis.