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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.
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Incidence: 1% to 3% are present at birth, 10% to 12% are present by 1 year of age
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Age: majority (80%) become apparent between 2 and 5 weeks of age; 20% are noted at birth.
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Sex: females are affected two to four times more than males
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Precipitating factors: premature infants are more commonly affected
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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.
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DIFFERENTIAL DIAGNOSES
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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.
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Proliferations of plump endothelial cells that may extend from the superficial dermis to the deep subcutaneous tissue, depending on the hemangioma subtype.
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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.
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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.
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Bleeding and ulceration with secondary infection and scarring, especially in hemangiomas involving the diaper area, are commonly seen. Other serious complications include orbital obstruction ...