Haemangioma Flashcards
Define haemangioma
Benign vascular lesions that typically appear in the first weeks of life as macules/patches. They enter a proliferative phase and may become elevated above the surrounding skin surfaces
What are the types of haemangioma
Vascular tumour:
Infantile haemangioma
Congential haemangioma
Pyogenic Granuloma
Kaposiform haemangioendothelioma
Vascular malformation:
Capillary malformation (port-wine stain)
Venous malformation
Lymphatic malformation
Arteriovenous malformation
What is an infantile haemangioma and what are the risk factors
“Strawberry naevus”
Usually not present at birth, but appear in the first month of life and may be multiple.
RF: preterm delivery
What are the symptoms and signs of infantile haemangioma
Develops a few days/weeks after birth OR present at birth
Lasts 6-10 months, then shrinks
Red/pink/blue colour, multilobed tumours
Soft and not fixed haemangioma
Tight and tense surface and may swell with crying or dependency
Common sites include the face, scalp and back
What is the management for infantile haemangiomas
Small lesions → no treatment, re-assure
Medical photography + review in 3 months
Advice:
- Should not have treat to function, minimal risk of severe cosmetic deformity
- Bleeds easily, try not to catch it. If it does, apply pressure
- Use vaseline, avoid irritants
Regression may be sped up using topical timolol (beta blocker), especially if near eyes, lips, nappy area, nasal tip
Large lesion → oral propranolol
What are the complications of infantile haemangioma and what is the prognosis
Ulceration
Haemorrhage
Involution → residual changes (scarring, skin atrophy, redundancy, discoloration, telentgiectasia)
50% involute by 5 years, 70% involute by 7 years and 90% involute by 9 years
What are congenital haemangiomas
Present at birth, much rare than infantile haemangiomas
M = F
3 types:
1. Rapidly involuting congenital haemangiomas (RICH)
- i. Maximum size by birth and involutes by 12-18 months
2. Non-involuting congenital haemangiomas (NICH)
- i. Continues to grow as the baby grows and does not shrink after birth
3. Partially involuting congenital haemangiomas (PICH)
What are the signs of congenital haemangioma
Present at birth
Raised or flat, pink, or purple
Transient thrombocytopenia
What is the management for congenital haemangioma
Small lesions → no treatment, re-assure
Medical photography + review in 3 months
Advice:
- Should not have threat to function, minimal risk of severe cosmetic deformity
- Bleeds easily, try not to catch it. If it does, apply pressure
- Use vaseline, avoid irritants
Removal required → embolisation
What are the complications of congenital haemangioma and what is the prognosis
Heart failure (if large enough → high blood flow)
For most patients, a haemangioma follows a predictable, uncomplicated pattern of growth followed by slow involution lasting 1 to 8 years
Intense proliferative growth is complete by 5 months of age in 80% of patients with haemangioma. By 9 months of age, overall growth is almost always complete
What are capillary haemangiomas and what do they look like
“Stork bites”
Present at birth, resolves spontaneously
Pink macules on the upper eyelids, midforehead, and nape of the neck are common and arise from distension of the dermal capillaries. Those on the eyelids gradually fade over the first year; those on the neck become covered with hair
What is Sturge-Weber syndrome
Haemangiomatous facial lesion (Port-wine stain) int he distribution of the trigeminal nerve (ophthalmic division always involved) + intracranial lesion (ipsilateral leptomeningeal angioma)
Severe: epilepsy, intellectual disability, contralateral hemiplegia
What is the management for Sturge-Weber syndrome and what are the complications
Intractable epilepsy → hemispherotomy
port-wine stain → laser treatment
Does not spontaneously resolve
Darkens and becomes raised over time
Ipsilateral glaucoma in 50% of children (assess in neonatal period)
What features of a haemangioma necessitates referral
Function threatening (periocular, nasal tip, ear, lips, genitalia)
Large facial, anogenital, perineal
Lumbosacral
Ulcerating
“Beard” distribution (laryngeal haemangioma) → ENT referral
Multiple lesions (>5 → USS liver)
what is the difference between superficial and deep haemangioma
Superficial (50-60%): bright red area of skin, feels warm
Deep (15%): blue, forms a lump
