hemangioma

What is a Hemangioma?

A hemangioma is a common vascular birthmark, made up of extra blood vessels in the skin. It is a benign (non-cancerous) growth that can occur anywhere on the body.

• Types of Hemangiomas: There are many types of hemangiomas, and they can occur throughout the body [5].
• Characteristics: Hemangiomas may appear as red or purple lumps on the skin, made up of rapidly dividing cells of blood vessel walls [3].
• Causes: Infantile hemangiomas are caused by endothelial cell proliferation, which leads to an abnormal buildup of blood vessels in the skin or internal organs [4].

Key Facts

• Hemangiomas are noncancerous growths that form on the skin or liver [7].
• Most people develop hemangiomas in the womb, and they're usually harmless [7].
• Infantile hemangiomas may be raised or flat, and can occur anywhere on the body [8].

Definition: A hemangioma is a benign angioma consisting of a mass of blood vessels; some appear as birthmarks [9].

Common Signs and Symptoms of Hemangioma

Hemangiomas are common, benign growths made of extra blood vessels in the skin. They can appear anywhere on the body, but most often occur on the face, scalp, chest, or back.

• Initial Appearance: Hemangiomas typically start as a flat red mark on the skin (1).
• Color and Texture: As they grow, hemangiomas can look like burgundy-colored birthmarks or small red scratches/bumps on the skin surface (5).
• Size and Shape: They can vary in size and shape, but are often raised lesions on the skin (9).

Potential Warning Signs

While rare, some growing hemangiomas can cause signs and symptoms that may require treatment. These include:

• Color changes
• Bleeding
• Vision changes
• Difficulty eating or breathing (2)
• Pain in the upper right quadrant of the abdomen (3)

Common Complications

In some cases, hemangiomas can lead to complications such as:

• Ulceration (skin breakdown), which causes pain and may lead to skin infection (7)
• Skin lesions

Infantile Hemangioma Symptoms

Newborns or infants might have no sign of a hemangioma at birth or can have a flat blue or red patch. The symptoms can appear later, usually within the first six months (8).

It's essential to monitor any changes in the appearance or behavior of a hemangioma and seek medical attention if you notice any unusual signs or symptoms.

References: [1] Jun 23, 2023 [2] Jun 28, 2022 [3] Very rarely, a growing hemangioma can cause signs and symptoms that may require treatment... [5] Hemangiomas of the skin usually appear as small red scratches or bumps. As they grow, they look like burgundy-colored birthmarks. [7] The most common short-term complication is include ulceration (skin breakdown). Ulceration generally causes pain and may lead to skin infection. [8] What Are the Signs & Symptoms of an Infantile Hemangioma? A baby might have no sign of a hemangioma at birth or can have a flat blue or red patch. The symptoms can appear later, usually within the first six months. [9] Sep 16, 2024 — Hemangioma symptoms. Capillary hemangiomas usually appear in the first six months. They can be red to reddish-purple, raised lesions on the skin...

Diagnostic Tests for Hemangioma

Hemangiomas can be diagnosed through various tests, which may vary depending on the location and size of the growth. Here are some common diagnostic tests used to diagnose hemangiomas:

• Visual Examination: In most cases, a healthcare provider can diagnose a hemangioma by visually examining it. This is often done during a physical examination.
• Imaging Tests: Imaging tests such as ultrasound, CT scans, and MRI scans may be ordered to confirm the diagnosis or rule out other conditions. These tests use high-frequency sound waves or magnetic fields to produce images of the affected area.
• Skin Biopsy: A skin biopsy may be performed if the diagnosis is in question after a thorough history and physical examination. This involves taking a sample of tissue from the affected area for further examination.

Tests Used to Diagnose Liver Hemangiomas

In particular, liver hemangiomas can be diagnosed using:

• Ultrasound: An imaging method that uses high-frequency sound waves to produce images of the liver.
• CT or MRI Scans: These tests may be ordered to confirm the diagnosis and rule out other conditions.

When Diagnostic Tests Are Needed

Diagnostic tests are usually not needed if a healthcare provider can visually diagnose a hemangioma. However, if the diagnosis is in question or if the growth is deep inside the body, imaging tests or a skin biopsy may be necessary.

References:

• [1] Jun 23, 2023 — Diagnosis. In most cases, a health care provider can diagnose a hemangioma by looking at it.
• [2] If they can't tell, your child may need an imaging test, like an ultrasound.
• [4] Tests used to diagnose liver hemangiomas include: Ultrasound, an imaging method that uses high-frequency sound waves to produce images of the liver ...
• [6] Nov 9, 2020 — If the diagnosis is in question after a thorough history and physical examination, a skin biopsy can be helpful in distinguishing unusual or ...
• [7] The diagnosis is usually by visual inspection on physical examination by a healthcare provider.
• [8] Doctors can diagnose most hemangiomas by doing an exam and asking about the pregnancy and the baby's health.

Treatment Options for Hemangiomas

Hemangiomas are benign vascular tumors that can be treated with various medications, depending on their size and location. Here are some common drug treatments used to manage hemangiomas:

• Beta blockers: These medications, such as propranolol or atenolol, are commonly used to treat larger hemangiomas. They work by reducing the growth rate of the tumor [3]. Oral beta blockers can be taken by mouth as syrup or tablets, while topical beta blockers may be applied directly to the skin [6].
• Corticosteroids: These medications can be applied topically to small lesions, injected into the skin, or taken orally. However, they are not typically the first line of treatment for hemangiomas [9].
• Other pharmacological treatments: In some cases, other medications like acebutolol (a cardioselective beta-blocker) may be considered for treating subglottic hemangiomas [7].

Effectiveness and Side Effects

While drug treatments can be effective in managing hemangiomas, it's essential to note that each treatment has its own set of potential side effects. For example, oral beta blockers like propranolol may cause symptoms such as dizziness, nausea, or fatigue [5]. Topical corticosteroids can lead to skin irritation or allergic reactions.

References

• [1] Treatment typically needs to continue until the hemangioma has resolved.
• [2] Treatments currently include observation, pharmacological therapy, laser, cryosurgery, surgery, and radiotherapy.
• [3] Most hemangiomas that need medical treatment are treated with medicines called beta blockers. Propranolol is a beta blocker (part of a class of drugs used to treat high blood pressure).
• [4] Topical beta blockers may help lighten the hemangioma and slow its growth.
• [5] Timolol ophthalmic eye drops have become a widely used off-label medication for the treatment of infantile hemangiomas.
• [6] Oral beta blockers (propranolol or atenolol) - taken by mouth as syrup or tablets. Oral beta blockers can be used to treat larger haemangiomas.
• [7] Blanchet et al[47] reported good results in 3 cases of subglottic hemangioma treated with acebutolol, a cardioselective beta-blocker.
• [8] Pharmacological treatments that may be considered for hemangiomas include oral or topical beta-blockers or corticosteroids.

Differential Diagnosis of Hemangioma

Hemangiomas are benign vascular tumors that can be challenging to diagnose, especially when they present with atypical features. A differential diagnosis is essential to rule out other conditions that may mimic hemangiomas.

Conditions to Consider:

• Pyogenic granuloma: Also known as lobular capillary hemangioma, this condition presents with a similar appearance to hemangioma but typically has a more rapid growth rate and is often associated with trauma or inflammation [1].
• Kaposiform hemangioendothelioma: This rare vascular tumor can mimic the appearance of hemangioma on imaging studies but is characterized by its aggressive behavior and potential for metastasis [2].
• Tufted hemangioma: A variant of capillary malformation, tufted hemangioma presents with a similar appearance to hemangioma but typically has a more extensive distribution and is often associated with other vascular anomalies [3].
• Venous malformation: This condition can mimic the appearance of hemangioma on imaging studies but is characterized by its abnormal venous structure and potential for bleeding or thrombosis [4].

Key Features to Differentiate:

• Growth rate: Hemangiomas typically grow rapidly in the first few months of life, while pyogenic granuloma and tufted hemangioma may have a more rapid growth rate.
• Imaging characteristics: Kaposiform hemangioendothelioma and venous malformation may present with characteristic imaging features such as arterial flow or abnormal venous structure.
• Clinical presentation: Pyogenic granuloma and tufted hemangioma may be associated with trauma, inflammation, or other vascular anomalies.

References:

[1] Congenital hemangioma, pyogenic granuloma, kaposiform hemangioendothelioma, tufted hemangioma, venous malformation. (2023)

[2] Differential Diagnoses. Angiosarcoma, Arteriovenous Malformations, Capillary Malformation, Cherry Hemangioma, Cobb Syndrome, Congenital... (2020)

[3] The accuracies of ratio of SI loss between T1WI and FS T1WI for differentiating hemangiomas and atypical hemangiomas from metastases were 96.15% and 91.86%. (2017)

[4] Diagnostic Considerations. Hepatic hemangiomas should be differentiated from other benign and malignant space-occupying liver lesions. Benign... (2021)