Hemangiomas can present spontaneously during birth but usually appear within the first several months of the infant’s life. Hemangioma initiates as a small solitary lesion or multiple red marks notably seen in the face, chest, back, and scalp. Consequently, the small red mark progressively increases in size within the first year of life until it protrudes as a spongy mass on the skin. The lesion eventually enters a lag phase or “rest phase” until it starts to slowly resolve by involution. Majority of the hemangioma resolves by 10 years old but the skin discoloration left behind may be permanent.

• Pain

  Pain and neurological symptoms derived from hemangiomas as shown in 2-11% of the cases. The 55% of these cases presents low back pain, while the 45% presents neurological deficit from compression of the spinal cord, peripheral nerves or both. [ncbi.nlm.nih.gov]

  Collapse of the vertebral body or encroachment into the neural canal are some of the classic causes of pain. An increase in activity can cause the vertebral hemangioma to become painful, such as starting to exercise, housework and such. [radiopaedia.org]

  Lesions can bleed or ulcerate from minor trauma; ulcers may be painful. IH in certain locations can interfere with function. [merckmanuals.com]

  Computed tomography scan of the abdomen in a 51-year-old man presenting with chronic cough, nausea, and abdominal pain. The left lobe of the liver is completely replaced by a 16 × 11 × 12 cm 3 mass. [jaoa.org]

  (OBQ06.119) A 17-year-old male presents to your office with hand swelling and intermittent pain. His pain occurs when his hand is held in a dependent position or when he is swimming. [orthobullets.com]

• Asymptomatic

  Most hemangiomas are asymptomatic. Collapse of the vertebral body or encroachment into the neural canal are some of the classic causes of pain. [radiopaedia.org]

  A complete surgical excision was performed under general anesthesia, and the child was asymptomatic at follow-up of two months. [ncbi.nlm.nih.gov]

• Swelling

  Bone window of the same [Figure - 4] revealed complete erosion of the parietal bone underlying the swelling. A CECT through the swelling [Figure - 5] showed areas of necrosis and calcification within the swelling. [ijri.org]

  However, if they are just under the skin they often appear as a bluish swelling. The next most common location is on the liver. Hemangiomas can also grow in other internal organs, such as the larynx, or small and large intestine. [columbiadoctors.org]

  He had observed a swelling of the right cubital fossa over the past 2 years, leading to the limitations of elbow extension and forearm pronation. The patient was diagnosed with intramuscular hemangioma of the biceps brachii. [ncbi.nlm.nih.gov]

  The patients usually complain about progressive and painless swelling in facial-parotid region. Due to its location, 90% of all intramuscular hemangiomas are misdiagnosed and often clinically mistaken as a parotid swelling. [atif.sobiad.com]

• Inflammation

  Abstract Extracardiac uptake on SPECT MPI, seen with physiologic radiotracer distribution, benign or malignant neoplasm, infection, inflammation, or granulomatous disease, may confound the accuracy of MPI or lead to unsuspected pathology. [ncbi.nlm.nih.gov]

  Hemangioma symptoms Most hemangiomas are symptom-free, but symptoms may include: Back pain Pain that radiates along a nerve due to inflammation or irritation of the nerve root Spinal cord compression [upmc.com]

  Corticosteroid medication Corticosteroids may be injected into a hemangioma to reduce its growth and to stop inflammation. Systemic steroids, such as prednisone and prednisolone, are not typically used anymore. [healthline.com]

• Weakness

  All cases of EHE and EAS lacked FOSB immunoreactivity or showed only incidental weak FOSB immunoreactivity in less than 5 nuclei per lesion. [ncbi.nlm.nih.gov]

  On physical examination, she demonstrated weakness in the hip extensors and knee flexors (left more than right) and a left Babinski sign. Left-side reflexes were decreased. [ajnr.org]

  […] and it is expected to remain weak in the near term. [collinsdictionary.com]

  Common symptoms are: lower back pain, pain and weakness of the legs, walking problems, and bladder and bowel loss of control. "Occult spinal dysraphism" is the term used when the defect of the spine is hidden under normal skin. [clinicaltrials.gov]

  If left untreated, those expanding lesions can cause weakness in the legs, problems with walking or paralysis. Treatment Vertebral hemangiomas that aren't causing symptoms require no treatment. [livehealthy.chron.com]

• Nausea

  Computed tomography scan of the abdomen in a 51-year-old man presenting with chronic cough, nausea, and abdominal pain. The left lobe of the liver is completely replaced by a 16 × 11 × 12 cm 3 mass. [jaoa.org]

  These tumors may cause abdominal discomfort and bloating and, less often, loss of appetite, nausea, a feeling of being full after eating a small meal, or pain. In infants, hemangiomas usually disappear on their own. [merckmanuals.com]

• Abdominal Pain

  Computed tomography scan of the abdomen in a 51-year-old man presenting with chronic cough, nausea, and abdominal pain. The left lobe of the liver is completely replaced by a 16 × 11 × 12 cm 3 mass. [jaoa.org]

  Most hepatic hemangiomas are asymptomatic, and they can cause right upper quadrant abdominal pain associated with necrosis or capsular distension as the tumor grows. [jtraumainj.org]

  pain or fullness due to hemorrhage, thrombosis or mass effect. [en.wikipedia.org]

  We describe the case of a previously healthy 46-year-old female without a history of exposure to carcinogens who presented with abdominal pain for two months. [ncbi.nlm.nih.gov]

• Vomiting

  […] approximately 20% Occur more commonly in women These lesions tend to be stable, though may enlarge during pregnancy or with estrogen administration Clinical findings Usually asymptomatic and discovered incidentally Large lesions may cause pain, nausea, or vomiting [learningradiology.com]

  The most common symptoms of hemangioblastoma include headache, nausea and vomiting, gait disturbances, and poor coordination of the limbs. Symptoms of hemangiopericytoma depend on the location of the tumor. [abta.org]

  For example, a hemangioma affecting the gastrointestinal tract or liver may present with symptoms such as: nausea vomiting abdominal discomfort loss of appetite a feeling of fullness in the abdomen The diagnosis is usually by visual inspection on physical [healthline.com]

• Diarrhea

  Página 54 - Pedigree demonstrating a sex-linked recessive condition characterized by draining ears, eczematoid dermatitis and bloody diarrhea. ‎ Página 51 - Selective IgA deficiency: presentation of 30 cases and a review of the literature. ‎ [books.google.es]

  However, a range of diarrhea, sleep disturbances, peripheral coldness and agitation was reported in the literature. [nature.com]

  Beta-Blockers Propranolol (Hemangeol™) by mouth Timolol* (Timoptic-XE®) gel drops Atenolol (Tenormin®) by mouth Nadolol (Corgard®) by mouth Trouble sleeping Cold hands and feet Diarrhea Nausea Vomiting Low blood pressure A slow heartbeat Trouble breathing [effectivehealthcare.ahrq.gov]

  This is generally well-tolerated but may be associated with sleep disturbance, diarrhea, bronchial hyper-reactivity, and hypoglycemia. Dosing with feeds is recommended. [f1000research.com]

• Loss of Appetite

  These tumors may cause abdominal discomfort and bloating and, less often, loss of appetite, nausea, a feeling of being full after eating a small meal, or pain. In infants, hemangiomas usually disappear on their own. [merckmanuals.com]

  If a hemangioma is larger than 4 cm in diameter, it may cause the following symptoms: abdominal discomfort and bloating nausea loss of appetite pain a sense of fullness after eating a small meal In severe cases, a larger hemangioma can rupture. [medicalnewstoday.com]

  For example, a hemangioma affecting the gastrointestinal tract or liver may present with symptoms such as: nausea vomiting abdominal discomfort loss of appetite a feeling of fullness in the abdomen The diagnosis is usually by visual inspection on physical [healthline.com]

• Heart Disease

  He was being treated with β-blockers for chronic heart failure with hypertensive heart disease at Osaka Minato Central Hospital. [ncbi.nlm.nih.gov]

  Propranolol- is a medication used for heart disease belonging to the beta blocker family and is now also the first line of treatment for hemangiomas. Usually it is taken orally and has a very favorable safety profile. [aapos.org]

  (npr. propranolol.definición de Hemangioma y sinónimos de Hemangioma (español), antónimos y red semántica multilingüe (traductores por 37 lenguas).The Source Of Teas That Fight Strokes Heart Disease And Cancer The Amazing Tea Tree - sur le blog geypreser [adpushup.tk]

  Baseline electrocardiogram is recommended to rule out underlying heart block in infants with a personal or family history of arrhythmia, congenital heart disease, or maternal connective tissue disease, according to consensus statement guidelines. [cancertherapyadvisor.com]

• Vascular Disease

  Age and physical activity are some of the main factors for the occurrence of cerebral vascular diseases. [rauche.net]

• Visual Impairment

  The patient was checked for possible brain, cardiac and vascular malformations and visual impairment. The IH improved and at the age of eleven months there were no adverse effects to the propranolol or IH progression. [cris.maastrichtuniversity.nl]

  Eyes A haemangioma that closes the eye or presses on the eye in the early weeks of life can produce a permanent visual impairment. Mouth Large haemangiomas around the mouth may interfere with sucking and feeding. [schn.health.nsw.gov.au]

  IHs may cause many complications, particularly during their proliferative phase, including ulceration, visual impairment, and airway obstruction3. [nature.com]

  Facial, anal, vulvar or mammary haemangiomas may give rise to functional impairment or ulceration [1, 2]. Periorbital haemangiomas may cause visual impairment with amblyopia or anisometropia. [smw.ch]

• Ulcer

  Lesions can bleed or ulcerate from minor trauma; ulcers may be painful. IH in certain locations can interfere with function. [merckmanuals.com]

  Ulceration. This is the most frequent complication. Ulceration can occur in children with focal and segmental hemangiomas. [vbiny.org]

  Ulceration and bleeding is uncommon. They can however develop in areas other than the skin (eg. liver, lung etc.) (extracutaneous). What causes ulcerated cavernous hemangiomas? The exact cause of ulcerated cavernous hemangiomas is not known. [nicklauschildrens.org]

  Ulceration: Sometimes an ulcer can form. This can be painful, and a scar may remain after the hemangioma disappears. A doctor may prescribe antibiotics to prevent infection. A hemangioma that forms on the lips can cause ulcers to develop. [medicalnewstoday.com]

  Lesions can bleed or ulcerate from minor trauma; ulcers may be painful. Infantile hemangiomas in certain locations can interfere with function. [msdmanuals.com]

• Skin Bleeding

  Hemangioma Before and After Case Before After Bleeding The most common complication of hemangiomas is bleeding. Bleeding occurs because the skin overlying the hemangioma is much thinner and more friable than normal. [chla.org]

  Possible side effects of laser treatments include: A scar Changes in skin color (light spots or dark spots*) Thinning of the skin Bleeding Blistering Infection * Researchers found that light spots are more common than dark spots. [effectivehealthcare.ahrq.gov]

• Skin Ulcer

  Most hemangiomas do not cause any other physical problems, although it is possible that some may be associated with skin ulceration and bleeding. [columbiadoctors.org]

  Larger hemangiomas may complicate to skin ulcerations which are harder to treat and are almost always considered aesthetically challenging. [symptoma.com]

  Complications of this approach include local skin ulceration, soft tissue necrosis, mucosal sloughing, or nerve injury. Embolization provides temporary control of disease, but recurrence is high [61]. [hindawi.com]

• Joint Effusion

  Synovial hemangioma is rare and almost always involves the knee joint, with patients presenting with pain, swelling, and joint effusion. The most common site of involvement is the suprapatellar pouch. [pubs.rsna.org]

• Confusion

  On an analysis of various scientific articles and latest edition of medical text books an inappropriate use of various terms for vascular lesions was found, contributing further towards the confusion. [ncbi.nlm.nih.gov]

  Sometimes an haemangioma may be confused with a malignant melanoma, if both are dark in colour and of recent origin. [patient.info]

  Lobular capillary hemangioma Lobular capillary hemangiomas can grow very fast and can be initially confused for cancer. Some tumours develop after an injury and they are more common in women who are pregnant. [mypathologyreport.ca]

  Clinical description RICH have long been confused with infantile immature hemangiomas but are now clearly distinguished on the basis of their distinctive clinical, histological and immunephenotypic features. [orpha.net]

• Irritability

  Corticosteroids – The most common side effects of this medication are irritability, swelling of the face, stomach irritation, and problems with sleep with short-term use. All of these side effects disappear when the medication is stopped. [cincinnatichildrens.org]

  Hemangioma symptoms Most hemangiomas are symptom-free, but symptoms may include: Back pain Pain that radiates along a nerve due to inflammation or irritation of the nerve root Spinal cord compression [upmc.com]

  If irritated by clothing or a diaper seam, the hemangioma may be covered with petroleum jelly and a light gauze dressing to protect it from being rubbed and irritated. Stress Often, hemangiomas occur on the face or trunk. [chla.org]

• Headache

  Benign vascular neoplasms with a slow grow rate Clinical Presentation: Most often an incidental finding When symptomatic, may present with headache, dizziness, eye pain, and proptosis. [ajnr.org]

  Neurological examination revealed no abnormalities other than the slight headache. No abnormalies were found in the remaining examinations. [bmccancer.biomedcentral.com]

  The most common symptoms of hemangioblastoma include headache, nausea and vomiting, gait disturbances, and poor coordination of the limbs. Symptoms of hemangiopericytoma depend on the location of the tumor. [abta.org]

  Beta-Blockers Propranolol (Hemangeol™) Taken by mouth daily Beta-blockers are used to treat many conditions, such as high blood pressure, irregular heartbeat, and migraine headaches. [effectivehealthcare.ahrq.gov]

• Seizure

  […] arteriovenous malformations Combinations Klippel-Trenaunay syndrome has abnormal capillaries, veins, and lymphatics, often with overgrowth of the involved region Sturge-Weber syndrome may involve abnormal capillaries in the upper face, with glaucoma, seizures [uphs.upenn.edu]

  One patient died of congestive heart failure,23 another from seizures, pneumonia, and sepsis,6 and the third from pneumonitis and possibly congestive heart failure.4 Of the 2 remaining deaths, one was the result of progressive neurologic decline during [jamanetwork.com]

  Sturge-Weber Syndrome Sturge-Weber syndrome is a neurocutaneous syndrome (phakomatosis) characterized by facial port-wine nevus, seizures, glaucoma, buphthalmos, and mental retardation (, 51 ). [pubs.rsna.org]

  […] growth retardation; L: laryngeal; MFI: materno-foetal infection; MRS: mild respiratory symptoms; ND: not determined; *ongoing treatment; P: pharyngeal; Pl: propranolol; Pr: prematurity; PRM: premature rupture of membrane; RD: respiratory distress; S: seizure [medicaljournals.se]

  Symptoms of SWS are variable among cases and include intractable seizures, mental retardation, and glaucoma. CM may also be present in Klippel-Trenaunay Syndrome (KTS). [hindawi.com]

• Neglect

  The greater majority of hemangiomas do not require any treatment; thus, physicians often recommend observation or benign neglect of the disease’s symptomatology. [symptoma.com]

  Enucleation of giant hemangiomas of the liver: technical and pathologic aspects of a neglected procedure. Ann Surg 1992; 216:673–676. 13. Ishak KG, Rabin L. Benign tumors of the liver. Med Clin North Am 1975; 59:995–1013. 14. McArdle CR. [ekjm.org]

  Technical and pathologic aspects of a neglected procedure. Ann Surg 1992;216:673–676. Adam YG, Huvos AG, Fortner JG: Giant hemangiomas of the liver. Ann Surg 1970;172:239–245. [karger.com]

The diagnosis of hemangioma is done clinically by a thorough history taking and a meticulous physical examination of the affected skin areas. Diagnostic tests are no longer required to verify the diagnosis. Although imaging modalities like magnetic resonance imaging (MRI) can be used to rule out other soft tissue masses that mimic hemangioma lesions.

The greater majority of hemangiomas do not require any treatment; thus, physicians often recommend observation or benign neglect of the disease’s symptomatology [8]. Although, parents of child patients often feel that the hemangioma may deem immediate treatment to be necessary for the fear of a permanent disfiguring mark that can cause psychological stigmata to the growing child. Treatment interventions may be necessary for hemangiomas that causes obstruction of vision and breathing.

Patients can be given corticosteroids which can directly be injected to the nodule, given orally, or topically applied on the affected skin [9]. However, the use of corticosteroids has inherent side effects like high blood sugar, poor growth, high blood pressure, and infantile cataracts. Laser surgery is utilized to remove hemangioma and treat non-healing sores on the fleshy lesions [10]. Pain, infection, bleeding, and scarring are relatively common side effects of this type of treatment.

In general, there is a good outlook for patients presenting with superficial hemangioma because they usually resolve without therapeutic interventions. Almost 50% of these skin lesions disappear by 5 years old of age, and almost all lesions resolve by the age of 9 years old. Larger hemangiomas may complicate to skin ulcerations which are harder to treat and are almost always considered aesthetically challenging.

The exact etiology of hemangioma is still unknown up to this time, although, theories have postulated that there might be some hereditary links in the causation of the disease process. Researches from Stanford Children’s Surgical laboratory have suggested that localized tissue hypoxia coupled with increased levels of estrogen just before childbirth contributes significantly in the etiology of hemangioma [1].

Another recent etiologic theory has been proposed from Harvard University and Arkansas University that hemangiomagenesis is a direct effect of placental embolization to fetal dermis during the time of gestation [2]. Currently, there are more and more researches conducted to determine the pathogenesis of hemangioma and find a therapeutic breakthrough to stop its menace.

In the United States, approximately 1 to 2% of hemagiomas appear at birth while 10% of infantile hemangioma occur within 1 year from birth in white infants [3]. The relative incidence of hemangioma among infants with lower birth weights climbs to 22% especially among infants having less than 1.5 kg of birth weight [4]. The risk of developing infantile hemangioma is relatively increased with older maternal age, uncontrolled preeclampsia, and maternal placenta previa [5].

It has been hypothesized that during the third trimester of fetal life, the immature endothelial cells along with the immature pericytes exist, which continue their proliferative capacity for only a limited period of time during the postnatal period [6]. At the same time, the angiogenic peptides like the vascular endothelial growth factor, beta-fibroblast growth factor, and proliferating cell nuclear antigen also propagate these immature cells resulting to a hemangioma. Tissue inhibitors of metalloproteinases (TIMP) with the interferon from the mast cells causesthe cessation of the endothelial cell proliferation. This process also triggers the involution of the enodothelial cells through programmed cell death or senescence [7].

Hemangioma occurs spontaneously at birth or within a few months from birth. This lesion is not preventable in any way. Lesions that develop sores, bleed, or ulcerate must be brought in for immediate surgical intervention to prevent untoward complications.

Hemangiomas are vascular anomalies that appear bright red and rubbery on the skin surface of afflicted individuals. Hemangioma appearing since infancy usually evolves to a less conspicuous lesion when the child reaches the age of 10 years. Hemangioma can technically occur in almost all parts of the body but they are most commonly seen on the face, scalp, back, and chest regions.

Definition

Hemangiomas are vascular anomalies that appears bright red and rubbery on the skin surface of afflicted infants which usually recede with time. 

Cause

The exact etiology remains unknown. Hereditary transmission is currently considered as one of the possible causes. The development of hemangioma is theorized to have been caused by local tissue hypoxia with high levels of estrogen concentration in serum. Placental embolization is one of the leading theories considered for hemangiomagenesis. 

Symptoms

Hemangiomas appear as a solitary or multiple red mark on the skin surface. These lesion may gradually raise and spread fast in time. Majority of these lesions resolve in time. 

Diagnosis

A thorough clinical diagnosis is all that is needed to diagnose hemangioma. No further tests are required to confirm the diagnosis.

Treatment and follow-up

Most hemangioma lesions does not require treatment. Hemangioma that obstructs vision or interferes with breathing may be treated with corticosteroid therapy or surgical laser therapy for its removal.

1. Kleinman ME, Greives MR, Churgin SS, et al. Hypoxia-induced mediators of stem/progenitor cell trafficking are increased in children with hemangioma. Arterioscler. Thromb. Vasc. Biol. 2007 27 (12): 2664–70.
2. Barnés CM, Huang S, Kaipainen A, et al. Evidence by molecular profiling for a placental origin of infantile hemangioma. Proc. Natl. Acad. Sci. U.S.A. 2005 102 (52): 19097–102.
3. Jacobs AH. Strawberry hemangiomas; the natural history of the untreated lesion. Calif Med. Jan 1957; 86(1):8-10.
4. Amir J, Metzker A, Krikler R, Reisner SH. Strawberry hemangioma in preterm infants. Pediatr Dermatol. Sep 1986; 3(4):331-2.
5. Haggstrom AN, Drolet BA, Baselga E, et al. Prospective study of infantile hemangiomas: demographic, prenatal, and perinatal characteristics. J Pediatr. Mar 2007; 150(3):291-4.
6. Takahashi K, Mulliken JB, Kozakewich HP, Rogers RA, Folkman J, Ezekowitz RA. Cellular markers that distinguish the phases of hemangioma during infancy and childhood. J Clin Invest. Jun 1994; 93(6):2357-64.
7. Ritter MR, Reinisch J, Friedlander SF, Friedlander M. Myeloid cells in infantile hemangioma. Am J Pathol. Feb 2006; 168(2):621-8.
8. Margileth AM, Museles M. Cutaneous hemangiomas in children. Diagnosis and conservative management.JAMA. Nov 1 1965; 194(5):523-6.
9. Frieden IJ, Eichenfield LF, Esterly NB, Geronemus R, Mallory SB. Guidelines of care for hemangiomas of infancy. American Academy of Dermatology Guidelines/Outcomes Committee. J Am Acad Dermatol. Oct 1997; 37(4):631-7.
10. Garden JM, Bakus AD, Paller AS. Treatment of cutaneous hemangiomas by the flashlamp-pumped pulsed dye laser: prospective analysis. J Pediatr. Apr 1992; 120(4 Pt 1):555-60.