Management of Hemangiomas in Infants

Giant Haemangioma in the Newborn

“…Considering the group of 42 recorded cases as a whole, there was a general pattern of early enlargement followed by involution, a pattern found in the present series, and in large series of untreated strawberry naevi (Lister, 1938;Lampe and Latourette, 1959;Simpson, 1959). This is strong evidence that giant haemangiomata, at least those complicated by thrombocytopenia, are in reality extremely large examples of strawberry naevi, the capillarycavernous, involuting form of infantile haemangioma.…”

“…Of the numerous papers in English or French only 3 have been found to contain descriptions of more than 2 cases. Lampe and Latourette (1959) in a review of 600 involuting types of haemangioma quoted only 2 examples, and Dargeon (1960) quoted only 5 from his extensive experience at the Memorial Hospital, New York. Consequently it is hard to gain from the literature a clzar picture of the natural history and management of this rare condition.…”

“…Microscopically it does not seem to differ fundamentally from the smaller strawberry naevi (capillary-cavernous haemangiomata) which most writers group with the involuting forms of haemangioma. These lesions have been studied extensively in large series which show that if they are left untreated, spontaneous involution almost invariably results (Lister, 1938;Ronchese, 1953;Bivings, 1954;Modlin, 1955;Blackfield, Torrey, Morris, and Low-Beer, 1957;Lampe and Latourette, 1959;Simpson, 1959;OBrien, 1964). But the giant haemangioma is much larger, with more frequent complications, and the literature has very few records of cases that have been simply observed, without some form of radical treatment-injection of sclerosing agents, irradiation, excision or amputation.…”

Complex Hemangiomas of Infants and Children

“…We elected to use resection in both circum¬ stances, strictly individualizing this form of therapy. The following indications for resection are suggested: (1) obstruc¬ tion ofthe visual axis; (2) large hemangiomas with thrombocy¬ topenia; (3) obstruction of luminal structures; (4) uncontrolla¬ ble ulcération, hemorrhage, or infection; (5) atypical growth suggesting alternative diagnosis; (6) cardiopulmonary de¬ compensation from arteriovenous shunting; and (7) small le¬ sions that can be excised without cosmetic or functional risk.…”

Hepatic Hemangiomatosis of Infancy

“…Hemangi omatosi s of infancy is a rare condition that is charac¬ terized by the clinical triad of (1) hepa¬ tomegaly, (2) shunts, leading to a high-output state and congestive heart failure.1 Hepatic hemangiomata are usually benign tu¬ mors that are present at birth or ap¬ pear soon afterward, enlarge progres¬ sively, and then, after a stationary period, undergo spontaneous involu¬ tion.2 When congestive heart failure is as¬ sociated with hepatic hemangiomata, treatment with cardiotonic measures alone is generally unsuccessful unless the hemangiomata undergo rapid and simultaneous involution.3 However, because spontaneous involution occurs slowly relative to the progress of con¬ gestive heart failure, several investi¬ gators have recommended more ag¬ gressive therapies, aimed at reducing the degree of arteriovenous shunting, in conjunction with cardiotonic mea¬ sures. Corticosteroids,46 radiation,M·7 and hepatic artery ligation813 have been used successfully in patients un¬ dergoing digitalization.…”