27 Congenital - Vascular Flashcards
What are the clinical differences b/w a hemangioma and vascular malformation
Vascular malformations are present at birth, grow proportionately with the child, and are associated with distortion or destruction of surrounding bone or cartilage; hemangiomas generally emerge after birth, proliferate and then regress, and do not affect surrounding bone or cartilage.
What are the typical clinical features of venous malformations
Soft, compressible, nonpulsatile mass m/c found on lip or cheek w/in H&N; also can be found w/in masseter muscle or mandible
What are the clinical features of AVM
brightly erythematous lesions of skin w/ an assoc thrill and bruit
What % of infants have a hemangioma by age 1
12%
What is the incidence of hemangiomas in premature infants weighing < 1000 g
23%
B/w what ages do hemangiomas grow most rapidly
8-18 months
What percent of hemangiomas regress by age 7
70%
Where exactly are most subglottic hemangiomas located
Posterolaterally and submucosally
What % of pts w/ subglottic hemangioma have an assoc cutaneous hemangioma
50%
What is m/c tx for hemangiomas
observation, parental reassurance
When is intervention for hemangioma warranted
- For massive, ulcerative, disfiguring lesions
- Hematologic, CV, upper aerodigestive tract compromise
- Large periorbital lesions obstructing vision
What syndrome is characterized by profound thrombocytopenia a/w hemangioma
Kasabach-Merritt syndrome
What are the 4 main types of vascular malformations
Capillary, venous, lymphatic, and arteriovenous malformations
What is m/c vascular malformation
Port wine stain (a capillary type)
What syndrome is characterized by capillary hemangiomas along the distribution of V1 w/ concomitant capillary, venous, and AVM of the leptomeninges
Sturge-Weber syndrome
What is the optimal tx for port wine stains
Argon laser in darker-skinned adults; flashlamp pulsed tunable dye laser in kids and lighter skinned adults
Which lesions respond best to PDL
Lesions less than 20 cm2 in kids < 1 year old
What are the 4 categories of lymphatic malformations
Capillary, cavernous, cystic (hygroma), and lymphangiohemangioma
Which lymphatic malformation is a/w episodic bleeding
Lymphangiohemangioma
Which lymphatic malformation is m/c found on tongue or floor of mouth
capillary
Which lymphatic malformation is a/w location in posterior triangle of neck
Cystic hygroma
Which lymphatic malformation is more likely to rapidly enlarge during an upper respiratory tract infection
Lymphangiohemangioma
“An infant has a left-sided suprahyoid lymphatic malformation. Using the DeSerres classification system, which class is this?
II
What are the indications for definitive tx of lymphatic malformations
When vital structures are endangered, when episodic hemorrhage occurs, or if macroglossia is present
Which lymphatic lesions are less likely to respond to sclerosis with OK-432 (Picibanil)
Microcystic, previously operated on, and those with massive craniofacial involvement
What condition is seen in adolescent pts with severe frequently recurring epistaxis and pulm AVMs
HHT (Auto Dom)
What are the advantages of using argon plasma coagulation for tx of HHT
- Noncontact application
- Limited and controlled tissue penetration with low risk of septal perforation
- No safety measures required (i.e. for lasers)
- Low thermal damage to adjacent tissue
- Inexpensive
