Can cavernous hemangiomas develop at any age?

Cavernous Hemangiomas Can Develop at Any Age

Yes, cavernous hemangiomas (now more accurately termed venous malformations) can develop at any age, from the neonatal period through adulthood, though they are typically congenital lesions that may become clinically apparent later in life. 1, 2

Understanding Vascular Anomalies Classification

• Vascular anomalies are divided into two main categories: vascular malformations and vascular tumors 1
• What were historically called "cavernous hemangiomas" are usually venous malformations (VMs) or deep infantile hemangiomas (IHs), representing a significant terminology confusion in the medical literature 1
• The International Society for the Study of Vascular Anomalies (ISSVA) classification system helps distinguish between these entities 1

Venous Malformations (Previously Called Cavernous Hemangiomas)

• Venous malformations are congenital lesions that are present at birth but may become clinically apparent only later in life 1
• They exhibit normal endothelial cell turnover throughout their natural history but may expand as the patient grows 1
• Growth may be influenced by trauma, infection, and hormonal changes 1
• Unlike infantile hemangiomas, venous malformations do not involute or regress spontaneously 1
• Cerebral cavernous malformations specifically have been documented in all age groups, including the neonatal period 2

Infantile Hemangiomas vs. Venous Malformations

• Infantile hemangiomas (IHs) are true vascular neoplasms with a characteristic life cycle 1
• IHs typically appear before 4 weeks of age, proliferate during early infancy, and begin involuting between 6-12 months of age 1
• Deep IHs were historically misclassified as "cavernous hemangiomas" but are biologically distinct from venous malformations 1
• IHs have a prevalence of approximately 4-5% of infants and are more common in females, whites, and premature infants 1

Clinical Presentation by Age

• In neonates and infants: Vascular malformations may be present but not always clinically apparent; infantile hemangiomas typically manifest within the first few weeks of life 1
• In children: Venous malformations may become more noticeable as the child grows; cerebral cavernous malformations may present with seizures 1, 3
• In adults: Venous malformations that were previously asymptomatic may become clinically apparent due to progressive ectasia from intraluminal flow 1
• Cerebral cavernous malformations have a population-based annual detection rate of 0.56 per 100,000 per year for adults >16 years of age 1

Diagnostic Considerations

• Accurate diagnosis is critical as treatment approaches differ significantly between vascular tumors and malformations 1, 4
• Ultrasound with Duplex Doppler is recommended as the initial imaging study to characterize lesions as low-flow or fast-flow 4
• MRI with contrast is the gold standard for comprehensive evaluation of vascular malformations 4
• Cerebral cavernous malformations may be detected incidentally in 20-50% of cases due to widespread availability of brain MRI 1

Clinical Implications

• Venous malformations require different management approaches than infantile hemangiomas 1, 4
• Treatment options for venous malformations include sclerotherapy, surgical excision, or combination approaches based on location and symptoms 5, 6
• For cerebral cavernous malformations, the annual hemorrhage risk varies (0.6%-60%), with higher rates for symptomatic and brainstem lesions 1
• Surgical excision is the treatment of choice for accessible, symptomatic cerebral cavernous malformations 2

The terminology confusion between infantile hemangiomas and venous malformations (formerly called cavernous hemangiomas) has led to significant diagnostic challenges. It's important to recognize that true venous malformations can become clinically apparent at any age, while infantile hemangiomas follow a predictable life cycle beginning in early infancy 1.