Pediatric Soft Tissue Hemangioma

Congenital soft tissue hemangioma

  • Etiology: vascular, capillaries intermixed with dilated vessels
  • US: variable, can be more heterogeneous, calcification, necrosis, shunting, variable margins and vascularity
  • DDX:
  • Complications:
  • Treatment: none, excision, embolization, ?steroids
  • Clinical: prenatal detection, proliferation ceases by birth, rapidly involuting (RICH) with involution over 3-12 months and non-involuting (NICH) with lesion staying stable and partially involuting (PICH) with partial involution of lesion, consumptive coagulopathy which is mild and transient, GLUT-1 negative

Infantile soft tissue hemangioma

  • Etiology: vascular, capillaries lined by plump endothelial cells
  • US: in cutaneous / subcutaneous tissue, solid with patchy increased echogenicity, variable margins, high vessel density on Doppler
  • DDX:
  • Complications: tend to be multiple, consider liver sonogram if >= 2 soft tissue lesions
  • Treatment: propranolol, steroids
  • Clinical: proliferation in first weeks-months of life, involution over years, no coagulopathy, GLUT1 positive, cherry red or blue depending on depth of lesion
  • Note: if lesion is:
    — Beard distribution – possible airway compromise due to association with subglottic hemangiomas
    — Periorbital – growth may compress optic nerve and cause blindness
    — Midline sacrum – do MRI to rule out spinal dysraphism
    — Unilateral facial distribution – consider PHACES syndrome

Radiology Cases of Soft Tissue Hemangioma

Radiograph and CT of soft tissue hemangioma
Lateral radiograph of the airway and axial CT without contrast of the neck shows a large heterogenous mass that displaces and compresses the trachea.

Clinical Cases of Soft Tissue Hemangioma

Clinical image of soft tissue hemangioma of toe
Clinical image shows a large, raised, red, coarse lesion involving almost the entire first toe.