L3: Hemangioma & AVM Flashcards
1
Q
Incidence of Hemangioma
A
- The most common benign tumor of infancy
2
Q
Sex in Hemangioma
A
Females are 3.5* in females
3
Q
Pathophysiology of Hemangioma
A
4
Q
Classification of Hemangioma
A
5
Q
Incidence of Vascular Malformations
A
Less frequent
6
Q
Sex in Vascular Malformations
A
Equal
7
Q
Pathophysiology of Vascular Malformations
A
8
Q
Classifications of Vascular Malformations
A
9
Q
Classification of Hemangioma
- Supificial
A
10
Q
Classification of Hemangioma
- Deep
A
11
Q
Classification of Hemangioma
- Mixed
A
12
Q
Classification of Vascular Malformations
- Slow Flow
A
13
Q
Classification of Vascular Malformations
- Fast Flow
A
14
Q
Classification of Vascular Malformations
- Complex Combined VMs
A
15
Q
Natural History of Hemangioma
A
16
Q
Natural History of Hemangioma
- Onset
A
- Not apparent at birth, appear around 2nd week of life. (with exceptions)
17
Q
Natural History of Hemangioma
- Growth
A
Grow rapidly over next 6-10 months (Proliferating phase).
18
Q
Natural History of Hemangioma
- Course
A
- Then a stationary course is followed by an involution phase (usually begins at 18 M.).
19
Q
Natural History of Hemangioma
- Regression
A
Then regress slowly over next 7-10 years.
20
Q
Natural History of Hemangioma
- Characters of Regression
A
21
Q
Natural History of VMs
A
22
Q
CP of Hemangioma
A
23
Q
CP of Hemangioma
- During proliferating Phase
A
24
Q
CP of Hemangioma
- During Involution Phase
A
25
CP of **VMs**
26
CP of **VMs**
- Capillary Malformations
27
CP of **VMs**
- Lymphatic Malformatioms
28
CP of **VMs**
- Venous Malformations
29
CP of **VMs**
- AVM
30
Complications of **Hemangioma & VMs**
31
Complications of **Hemangioma & VMs**
- KMS
- Some extensively large Hemangiomas may be complicated by coagulopathy & profound thrombocytopenia resulting from platelet trapping within the huge vascular lesion
32
Complications of **Hemangioma & VMs**
- HOHF
- This may occur withlarge Hemangiomas with intralesional arteriovenous shunting causing hyperdynamic circulation which increase the load on the heart.
33
Complications of **Hemangioma & VMs**
- Complications Related to Site
**Peri-orbital:** Interfere with visual axis, squint, amblyopia
**Large cervical cystic hygromas:** Airway obstruction
34
Dx of **Hemangioma & VMs**
35
Dx of **Hemangioma & VMs**
- Clinically
History & physicai examination may be sufficient for diagnosis.
36
Dx of **Hemangioma & VMs**
- Rad
- Ultrasonography & MRI are the principal useful imaging modalities.
- Doppler US characterize the flow of the vascular lesions (Hemangiomas & arteriovenous malformations are fast flow).
37
Dx of **Hemangioma & VMs**
- Doppler US
- Doppler US characterize the flow of the vascular lesions (Hemangiomas & arteriovenous malformations are fast flow).
38
Dx of **Hemangioma & VMs**
- Angiography
- Angiography indicate the extent of vascular involvement, show feeding & draining vessels, and can be used for selective embolization.
39
Management of **Hemangioma**
40
Management of **Hemangioma**
- Principals of TTT
41
Management of **Hemangioma**
- Observation
42
Management of **Hemangioma**
- Pharmacological TTT
- Propranolol
- CTS
43
Oral Proplanolol in **Hemangioma**
- Indications
- Now 1st line of treatment with excellent response, but with some precautions & possible side effects.
44
Oral Proplanolol in **Hemangioma**
- Dose
45
Oral Proplanolol in **Hemangioma**
- SE
46
Oral Proplanolol in **Hemangioma**
- CI
1. Congenital heart disease
2. Bronchial asthma
3. Chronic obstructive pulmonary diseasee
47
Oral Proplanolol in **Hemangioma**
- response
- Near complete or complete regression ir 60%
48
Systemic Corticosteroids in **Hemangioma**
- Indication
- Especially in: Large, Rapidly growing, complicated lesions.
49
Systemic Corticosteroids in **Hemangioma**
- Dose
- 5g/kg/ day prednisone. for 6-8 weeks up to 12 W in severe cases.
- Gradually withdrawn over 3 W.
50
Systemic Corticosteroids in **Hemangioma**
- Complicatioons
- Facial oedema
- Truncal odesity
- Growth retardation
- Immunological abnormalities with recurrent infections
51
Systemic Corticosteroids in **Hemangioma**
- Response
Good response in third of cases.
52
**LASER** therapy in **Hemangioma**
Most appropriate for large flat lesions with significant cosmetic disfigurement.
53
**Surgical Excison** therapy in **Hemangioma**
- Best option for lesions in hidden areas.
54
TTT of **Lymphatic Malformations**
- Surgical excison
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
TTT of **Lymphatic Malformations**
- Aspiration?
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
TTT of **Lymphatic Malformations**
- Aspiration & Bleomycin Sclerotherapy
- Aspiration & Bleomycin sclerotherapy is a very effective therapeutic alternative.
57
TTT of **Lymphatic Malformations**
- Urgent tracheostomy
Urgent tracheostomy may be required in large cystic hygroma with airway obstruction.
58
TTT of **Capillary Malformations**
- LASER is the treatment of choice lesion.
59
TTT of **Venous Malformations**
- Intralesional sclerotherapy is the mainstay of treatmen:
(Injection of sclerosing agents as fibrin glue, ethanolamine)
- Surgical resection reserved for well-localized lesions.
60
TTT of **AVM**
- The mainstay treatment: angiographic embolization alone or in combination with surgical
61
TTT of Choice
- Unnoticable Hemangioma
62
TTT of Choice
- Hemangioma
63
TTT of Choice
- Large, Rapid, Complicated Hemangioma
64
TTT of Choice
- Large, Flat Hemangioma
65
TTT of Choice
- hidden Hemangioma
66
TTT of Choice
- Cystic Hygroma
67
TTT of Choice
- Capillary malformations
68
TTT of Choice
- Venous Malformations
69
TTT of Choice
- AVM
