From the Guidelines
The evaluation and management of congenital hemangiomas should be approached with a multidisciplinary strategy, focusing on the specific subtype, and prioritizing observation for rapidly involuting congenital hemangiomas (RICH) and intervention for non-involuting congenital hemangiomas (NICH) and partially involuting congenital hemangiomas (PICH) that cause significant symptoms or cosmetic concerns. The initial assessment of congenital hemangiomas should include a detailed physical examination, imaging studies such as ultrasound with Doppler, and MRI, as well as occasional biopsy for cases where the diagnosis is uncertain 1. It's crucial to differentiate between RICH, which typically resolve spontaneously within the first year of life, and NICH or PICH, which may require intervention due to potential complications or cosmetic issues.
Key Considerations in Management
- Rapidly involuting congenital hemangiomas (RICH) typically do not require treatment beyond observation, as they involute spontaneously, mostly within the first year of life 1.
- Non-involuting congenital hemangiomas (NICH) and partially involuting congenital hemangiomas (PICH) may necessitate intervention, including surgical excision, if they cause functional impairment, pain, or significant cosmetic concerns.
- Unlike infantile hemangiomas, congenital hemangiomas do not typically respond to propranolol or other beta-blockers, as evidenced by guidelines focusing on infantile hemangioma treatment 1.
- Embolization may be considered for lesions with significant vascular flow that could lead to cardiac complications or to reduce bleeding risk before surgical excision.
- Laser therapy can be beneficial for treating residual telangiectasias or superficial components of the hemangioma.
Individualized Approach
The management of congenital hemangiomas should be highly individualized, taking into account the hemangioma subtype, location, size, associated complications, and patient factors. Psychological support for patients and families is also important, particularly for those with visible lesions, to address potential emotional and social impacts. Regular follow-up is essential to monitor for complications such as ulceration, bleeding, or cardiac issues, especially in cases with high-flow characteristics. By prioritizing a tailored approach based on the most recent and highest quality evidence, healthcare providers can optimize outcomes for patients with congenital hemangiomas, focusing on minimizing morbidity, mortality, and improving quality of life.
From the Research
Evaluation of Congenital Hemangioma
- Congenital hemangiomas (CHs) are rare congenital vascular tumors that can be diagnosed at birth or in utero 2, 3.
- The diagnosis of CH is primarily clinical, with imaging studies such as ultrasound, CT, or MRI used to confirm the diagnosis and evaluate the extent of the lesion 3, 4.
- CHs can be classified into two subtypes: rapidly involuting congenital hemangiomas (RICH) and non-involuting congenital hemangiomas (NICH) 3, 4.
Management of Congenital Hemangioma
- The management of CHs depends on the size, location, and symptoms of the lesion, as well as the presence of any complications such as cardiac failure or thrombocytopenia 2, 5.
- Medical therapy with corticosteroids and propranolol may be used to treat CHs, although the effectiveness of these treatments is not well established 2, 6.
- Interventional procedures such as embolization and surgical resection may be necessary in some cases, particularly for large or complicated CHs 2, 5.
- A multidisciplinary approach to treatment is recommended, involving pediatricians, dermatologists, radiologists, and surgeons as needed 2, 3.
Imaging Characteristics of Congenital Hemangioma
- CHs have distinctive imaging characteristics on ultrasound, CT, and MRI, including heterogeneity, visible vessels, and calcifications 4.
- RICH and NICH have different imaging features, with RICH tend to have more prominent vessels and calcifications, while NICH tend to have more well-defined limits and fat stranding 4.
- Imaging studies can help differentiate CHs from other vascular lesions, such as common infantile hemangiomas (COMMON) 4.