Current workup and therapy of infantile hemangiomas

2014 Revised Classification of Vascular Lesions from the International Society for the Study of Vascular Anomalies: Radiologic-Pathologic Update

“…Infantile Hemangioma.-By far the most common vascular anomaly encountered in children is the infantile hemangioma, which typically manifests as a single cutaneous lobular "strawberry mark" in the first few weeks of life (9)(10)(11). These lesions are most common in white females (3:1 female-to-male ratio).…”

“…These lesions are most common in white females (3:1 female-to-male ratio). Infantile hemangioma has a characteristic life cycle where it is not typically present at birth, appears and rapidly grows in the first few weeks/months of life (proliferative phase), gradually involutes over years (involutional phase), and remains as a variable amount of smaller fibrofatty tissue for the remainder of life (9)(10)(11). When a single lesion has a typical clinical history and cutaneous appearance for an infantile hemangioma in a nonconcerning location, no radiologic or histologic interrogation is necessary.…”

“…If five or more cutaneous lesions are present, abdominal US is necessary to screen the liver for infantile hemangiomas, which are typically small to medium-sized well-circumscribed masses (7,9,12,13) with multifocal or diffuse hepatic involvement. Hepatic infantile hemangiomas vary widely in echogenicity and vascularity, even during the early proliferative stage.…”

“…Complications of multifocal or diffuse infantile hemangiomas in the liver include hypothyroidism (due to production of type 3 iodothyronine deiodinase), heart failure (due to the hypothyroidism), liver failure, and abdominal compartment syndrome. Patients will require echocardiography and thyroxine (T 4 )/thyroid-stimulating hormone (TSH) monitoring, by which lesional response to therapy can be monitored (9,10,13).…”

“…Two other segmental distributions are associated with more widespread abnormalities that require screening of other organ systems. The PHACES association is found in the setting of segmental facial lesions, while the variably named LUMBAR/ PELVIS/SACRAL association (including lower body/truncal hemangioma, urogenital abnormalities, ulceration, myelopathy, bony anomalies, anorectal malformations, and arterial and renal abnormalities) is found with infantile hemangiomas extending over the spine and perineum (9)(10)(11)(12).…”