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Y4R4 - Surgery II 👨‍⚕️ > L3: Hemangioma & AVM > Flashcards

L3: Hemangioma & AVM Flashcards

1
Q

Incidence of Hemangioma

A
  • The most common benign tumor of infancy
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2
Q

Sex in Hemangioma

A

Females are 3.5* in females

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3
Q

Pathophysiology of Hemangioma

A
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4
Q

Classification of Hemangioma

A
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5
Q

Incidence of Vascular Malformations

A

Less frequent

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6
Q

Sex in Vascular Malformations

A

Equal

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7
Q

Pathophysiology of Vascular Malformations

A
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8
Q

Classifications of Vascular Malformations

A
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9
Q

Classification of Hemangioma

  • Supificial
A
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10
Q

Classification of Hemangioma

  • Deep
A
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11
Q

Classification of Hemangioma

  • Mixed
A
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12
Q

Classification of Vascular Malformations

  • Slow Flow
A
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13
Q

Classification of Vascular Malformations

  • Fast Flow
A
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14
Q

Classification of Vascular Malformations

  • Complex Combined VMs
A
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15
Q

Natural History of Hemangioma

A
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16
Q

Natural History of Hemangioma

  • Onset
A
  • Not apparent at birth, appear around 2nd week of life. (with exceptions)
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17
Q

Natural History of Hemangioma

  • Growth
A

Grow rapidly over next 6-10 months (Proliferating phase).

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18
Q

Natural History of Hemangioma

  • Course
A
  • Then a stationary course is followed by an involution phase (usually begins at 18 M.).
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19
Q

Natural History of Hemangioma

  • Regression
A

Then regress slowly over next 7-10 years.

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20
Q

Natural History of Hemangioma

  • Characters of Regression
A
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21
Q

Natural History of VMs

A
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22
Q

CP of Hemangioma

A
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23
Q

CP of Hemangioma

  • During proliferating Phase
A
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24
Q

CP of Hemangioma

  • During Involution Phase
A
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25
Q

CP of VMs

A
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26
Q

CP of VMs

  • Capillary Malformations
A
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27
Q

CP of VMs

  • Lymphatic Malformatioms
A
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28
Q

CP of VMs

  • Venous Malformations
A
29
Q

CP of VMs

  • AVM
A
30
Q

Complications of Hemangioma & VMs

A
31
Q

Complications of Hemangioma & VMs

  • KMS
A
  • Some extensively large Hemangiomas may be complicated by coagulopathy & profound thrombocytopenia resulting from platelet trapping within the huge vascular lesion
32
Q

Complications of Hemangioma & VMs

  • HOHF
A
  • This may occur withlarge Hemangiomas with intralesional arteriovenous shunting causing hyperdynamic circulation which increase the load on the heart.
33
Q

Complications of Hemangioma & VMs

  • Complications Related to Site
A

Peri-orbital: Interfere with visual axis, squint, amblyopia

Large cervical cystic hygromas: Airway obstruction

34
Q

Dx of Hemangioma & VMs

A
35
Q

Dx of Hemangioma & VMs

  • Clinically
A

History & physicai examination may be sufficient for diagnosis.

36
Q

Dx of Hemangioma & VMs

  • Rad
A
  • Ultrasonography & MRI are the principal useful imaging modalities.
  • Doppler US characterize the flow of the vascular lesions (Hemangiomas & arteriovenous malformations are fast flow).
37
Q

Dx of Hemangioma & VMs

  • Doppler US
A
  • Doppler US characterize the flow of the vascular lesions (Hemangiomas & arteriovenous malformations are fast flow).
38
Q

Dx of Hemangioma & VMs

  • Angiography
A
  • Angiography indicate the extent of vascular involvement, show feeding & draining vessels, and can be used for selective embolization.
39
Q

Management of Hemangioma

A
40
Q

Management of Hemangioma

  • Principals of TTT
A
41
Q

Management of Hemangioma

  • Observation
A
42
Q

Management of Hemangioma

  • Pharmacological TTT
A
  • Propranolol
  • CTS
43
Q

Oral Proplanolol in Hemangioma

  • Indications
A
  • Now 1st line of treatment with excellent response, but with some precautions & possible side effects.
44
Q

Oral Proplanolol in Hemangioma
- Dose

A
45
Q

Oral Proplanolol in Hemangioma

  • SE
A
46
Q

Oral Proplanolol in Hemangioma

  • CI
A
  1. Congenital heart disease
  2. Bronchial asthma
  3. Chronic obstructive pulmonary diseasee
47
Q

Oral Proplanolol in Hemangioma

  • response
A
  • Near complete or complete regression ir 60%
48
Q

Systemic Corticosteroids in Hemangioma

  • Indication
A
  • Especially in: Large, Rapidly growing, complicated lesions.
49
Q

Systemic Corticosteroids in Hemangioma

  • Dose
A
  • 5g/kg/ day prednisone. for 6-8 weeks up to 12 W in severe cases.
  • Gradually withdrawn over 3 W.
50
Q

Systemic Corticosteroids in Hemangioma

  • Complicatioons
A
  • Facial oedema
  • Truncal odesity
  • Growth retardation
  • Immunological abnormalities with recurrent infections
51
Q

Systemic Corticosteroids in Hemangioma

  • Response
A

Good response in third of cases.

52
Q

LASER therapy in Hemangioma

A

Most appropriate for large flat lesions with significant cosmetic disfigurement.

53
Q

Surgical Excison therapy in Hemangioma

A
  • Best option for lesions in hidden areas.
54
Q

TTT of Lymphatic Malformations

  • Surgical excison
A

Surgical resection is the only method for potentiai cure, but:

  • It is challenging because of the infiltrative nature of the lesion
  • Followed by high incidence of recurrence because complete resection is difficult
  • Possibly complicated by injury of important structures (trachea, oesophagus).
55
Q

TTT of Lymphatic Malformations

  • Aspiration?
A

Aspiration alone contraindicated

  • It will be followed rapidly by cecollection
  • It may be complicated byGemorrhage or infection with increases in size of the lesion.
56
Q

TTT of Lymphatic Malformations

  • Aspiration & Bleomycin Sclerotherapy
A
  • Aspiration & Bleomycin sclerotherapy is a very effective therapeutic alternative.
57
Q

TTT of Lymphatic Malformations

  • Urgent tracheostomy
A

Urgent tracheostomy may be required in large cystic hygroma with airway obstruction.

58
Q

TTT of Capillary Malformations

A
  • LASER is the treatment of choice lesion.
59
Q

TTT of Venous Malformations

A
  • Intralesional sclerotherapy is the mainstay of treatmen:
    (Injection of sclerosing agents as fibrin glue, ethanolamine)
  • Surgical resection reserved for well-localized lesions.
60
Q

TTT of AVM

A
  • The mainstay treatment: angiographic embolization alone or in combination with surgical
61
Q

TTT of Choice

  • Unnoticable Hemangioma
A
62
Q

TTT of Choice

  • Hemangioma
A
63
Q

TTT of Choice

  • Large, Rapid, Complicated Hemangioma
A
64
Q

TTT of Choice

  • Large, Flat Hemangioma
A
65
Q

TTT of Choice

  • hidden Hemangioma
A
66
Q

TTT of Choice

  • Cystic Hygroma
A
67
Q

TTT of Choice

  • Capillary malformations
A
68
Q

TTT of Choice

  • Venous Malformations
A
69
Q

TTT of Choice

  • AVM
A

Y4R4 - Surgery II 👨‍⚕️ (33 decks)

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