What is the difference between a congenital hemangioma and a congenital angioma of the face in a newly born neonate?

From the Guidelines

Congenital hemangiomas and congenital angiomas of the face in neonates are distinct vascular birthmarks with different characteristics and management approaches, as highlighted in the 2019 clinical practice guideline for the management of infantile hemangiomas 1. The key differences between these two conditions lie in their biological and behavioral characteristics. Congenital hemangiomas are fully grown at birth and can be classified into rapidly involuting (RICH) and noninvoluting (NICH) types, as noted in the 2015 study on the diagnosis and management of infantile hemangioma 1. In contrast, congenital angiomas, also known as capillary malformations or port-wine stains, are flat, pink to purple patches that do not regress spontaneously and grow proportionally with the child.

Some of the key characteristics of congenital hemangiomas include:

• Fully formed at birth
• Can be rapidly involuting or noninvoluting
• Typically appear as well-defined, raised, reddish-purple lesions with telangiectasias
• May have central pallor or ulceration As discussed in the 2016 report on infantile hemangiomas, these lesions usually appear by four weeks of age and stop enlarging by five months of age 1.

In terms of management, congenital hemangiomas may require observation, propranolol (2-3 mg/kg/day divided into 2-3 doses for 6-12 months), or surgical intervention if complications occur, as recommended in the 2019 clinical practice guideline 1. On the other hand, capillary malformations typically require pulsed-dye laser treatments starting in infancy. The distinction between these two conditions is crucial for appropriate treatment planning and parental counseling regarding expected outcomes.

It is essential to note that the management of congenital hemangiomas and congenital angiomas should prioritize minimizing morbidity, mortality, and improving quality of life. Early differentiation and appropriate treatment planning can significantly impact the outcome for these patients, as emphasized in the 2015 study on the diagnosis and management of infantile hemangioma 1. Therefore, it is crucial to consult with a specialist and follow the most recent clinical guidelines, such as the 2019 clinical practice guideline for the management of infantile hemangiomas 1, to ensure the best possible outcome for these patients.

From the Research

Difference between Congenital Hemangioma and Congenital Angioma

The terms "congenital hemangioma" and "congenital angioma" are often used interchangeably, but they refer to the same condition, which is a benign vascular tumor present at birth.

Subtypes of Congenital Hemangiomas

There are two main subtypes of congenital hemangiomas:

• Rapidly involuting congenital hemangioma (RICH) 2, 3, 4
• Noninvoluting congenital hemangioma (NICH) 2, 5, 4

Characteristics of RICH and NICH

Some key characteristics of RICH and NICH include:

• RICH:
  • Rapid involution during the first 12 to 30 months of life 6
  • May have a distinct angiographic appearance involving an arterial-capillary web, a dense tumor blush with identifiable feeding arteries, and variably present draining veins 5
• NICH:
  • Does not involute 2, 5
  • May have a similar angiographic appearance to RICH, but with no arteriovenous shunting 5
  • Can lead to considerable morbidity if not recognized and treated appropriately 5

Imaging Characteristics

Imaging characteristics of congenital hemangiomas can include:

• Heterogeneous appearance on ultrasound (US) 4
• Visible vessels on US 4
• Calcifications on US 4
• Well-defined limits on CT and/or MRI 4
• Fat stranding on CT and/or MRI 4

Clinical Features

Clinical features of congenital hemangiomas can include:

• Presence at birth 6, 2, 3, 5, 4
• Location on the head and neck, trunk, or extremities 6
• Size varying from 2.0 × 1.5 cm to 13.0 × 8.5 cm 6
• Potential for rapid involution or persistence 6, 2, 3, 5