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INTRODUCTION

Infantile hemangioma (IH), also known as strawberry, capillary, or cavernous hemangioma, is a benign endothelial proliferation that represents the most common tumor in infancy. It can be classified into superficial hemangioma (SH, 55% of cases), deep hemangioma (DH, 30% of cases), and mixed superficial and deep hemangioma (MH, 15% of cases). They occur most commonly on head and neck areas.

EPIDEMIOLOGY

Incidence: 1% to 3% are present at birth, 10% to 12% are present by 1 year of age

Age: majority (80%) become apparent between 2 and 5 weeks of age; 20% are noted at birth.

Sex: females are affected two to four times more than males

Precipitating factors: premature infants are more commonly affected

PHYSICAL EXAMINATION

The appearance depends on the depth of the hemangioma and the phase of evolution. SH presents as bright red-colored plaque. DH presents as a soft dermal or subcutaneous nodule with a bluish-purple color. MH shows features of both SH and DH. Multiple truncal hemangiomas may be observed. Involuting hemangiomas demonstrate a flatter surface with a grayish-purple hue that begins centrally and expands outward. The hemangiomas might become ulcerated and hemorrhagic. Residual fatty tissue, atrophy, telangiectasia, scar formation, and hypertrophy may be observed.

DIFFERENTIAL DIAGNOSES

Congenital hemangiomas can be confused with a vascular malformation such as port-wine stain at birth. Hemangiomas are generally present after birth versus vascular malformations, which are generally present at birth.

LABORATORY TESTS

Dermatopathology

Proliferations of plump endothelial cells that may extend from the superficial dermis to the deep subcutaneous tissue, depending on the hemangioma subtype.

Ancillary Tests

  • An abdominal ultrasound should be obtained if more than four truncal hemangiomas are noted prior to 4 months of age.

  • An electrocardiogram (ECG) and a cardiac ECHO should be considered for any concern of high cardiac output.

COURSE

Hemangiomas characteristically exhibit three phases of evolution: (a) proliferative phase, (b) involuting phase, and (c) involuted phase. The proliferating phase is characterized by a rapid growth phase that starts at 1 to 2 months of age and lasts until 6 to 9 months of age. This growth phase is followed by the involuting phase that usually starts in the second year of life and persists for several years. More than 90% of untreated hemangiomas involute, that is, attain maximal regression by 9 years of age. Up to 30% of hemangiomas leave postinvolution changes including hypopigmentation, scarring, telangiectasia, and fibrofatty tissue.

COMPLICATIONS

Bleeding and ulceration with secondary infection and scarring, especially in hemangiomas involving the diaper area, are commonly seen. Other serious complications include orbital obstruction and amblyopia with periorbital hemangiomas, upper airway obstruction with ...

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