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Infantile hemangioma in Child
See also in: External and Internal Eye,Anogenital
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Infantile hemangioma in Child

See also in: External and Internal Eye,Anogenital
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Contributors: Marilyn G. Liang MD, Elena B. Hawryluk MD, PhD, Susan Burgin MD
Other Resources UpToDate PubMed

Synopsis

Infantile hemangiomas are the most common benign tumors of infancy, occurring in up to 10% of infants, with up to 50% appearing in the head and neck. They may be present at birth and often become apparent within the first few months of life. Risk factors for infantile hemangiomas include female sex, being of Northern European descent, prematurity, being the product of multiple gestation, older maternal age, maternal progesterone use, placenta previa, and preeclampsia. Of infants with infantile hemangiomas, 75%-90% have a single hemangioma, usually on the head or neck. They may also be segmental or multifocal.

Usually, infantile hemangiomas are noticed at approximately 2-3 weeks of life. The initial proliferative phase usually lasts for about 1 year, with rapid growth during the first 4 months. This is followed by gradual involution over several years, with > 90% completely involuting by age 10. Although infantile hemangiomas involute with time, residual skin changes, such as telangiectasia, scarring, atrophy, and fibrosis, persist in up to 30% of lesions after involution is complete.

For more information, see OMIM.

Codes

ICD10CM:
D18.01 – Hemangioma of skin and subcutaneous tissue

SNOMEDCT:
83343001 – Infantile hemangioma

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Congenital hemangioma (CH) – Fully formed vascular tumors at birth; two main types are: rapidly involuting congenital hemangiomas (RICH) and non-involuting congenital hemangiomas (NICH), and variants have been reported. The proliferative phase in these tumors occurs in utero, and tumors typically do not proliferate postnatally as seen with infantile hemangiomas. CHs are characterized by hemispheric pink to purple vascular plaques with overlying telangiectasia and the characteristic peripheral rim of pallor. Both RICH and NICH may look similar; however, NICH is less impressive and flatter. Histologically, they are GLUT-1 negative, which helps to differentiate them from other hemangiomas.
  • Capillary malformation or "port-wine stain" – Early superficial or segmental infantile hemangiomas, or their precursor lesions, may be confused with port-wine stains, which are capillary malformations present at birth. They are pink or red patches that persist throughout life and do not have the typical growth phase of hemangiomas.
  • Sometimes tufted angioma and kaposiform hemangioendothelioma may mimic hemangiomas. They present as extensive brownish vascular plaques with deep fibrotic consistency.
  • Infantile myofibromatosis – Fibrohistiocytic proliferations characterized by skin-colored to purple, firm to hard or rubbery nodules.
  • Rhabdomyosarcoma – Soft tissue sarcoma of skeletal muscle origin typically seen in the first and second decades of life. In children, this presents as an asymptomatic, rapidly growing, red, firm cutaneous mass.
  • Deep infantile hemangiomas sometimes look similar to venous malformations, which do not go through a phase of rapid proliferation. Phleboliths are often seen in venous malformations. Bedside Doppler study or ultrasound imaging can help to differentiate these two entities.

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed: 08/15/2018
Last Updated: 09/12/2018
Copyright © 2019 VisualDx®. All rights reserved.
Infantile hemangioma in Child
See also in: External and Internal Eye,Anogenital
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Infantile hemangioma : Purple color, Tumor, Unilateral, Vascular plaque, Red
Clinical image of Infantile hemangioma
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