Bhargavi B Kola
Texas Tech University Health Sciences Center
USA
Title: Unique presentation and response to treatment of a cutaneous hemangioma with visceral extension.
Biography
Biography: Bhargavi B Kola
Abstract
2 month old female newborn was seen in her pediatric office for her well visit and vaccines. Was formula fed and was thriving well. Mother did have concerns about her red rash that she developed at birth (tiny swelling) which seemed to grow not just on the outside but also inside and wanted her to be evaluated. On exam she was a happy active baby with clear lungs and normal heart, all peripheral pulses felt and strong, abdomen –soft, non-tender with mass palpated within the left upper quadrant with an overlying erythematous soft swelling measuring about 3.75*2.8 cm in size consistent with hemangioma. It was vascular, non-tender, soft in consistency, mass below the swelling was freely mobile and with clear margins. Interestingly the temperature on the swelling was at least 1 degree Fahrenheit higher than the surrounding skin.
Past medical history: she is a product of normal vaginal delivery and no perinatal issues.
Ultrasound was then ordered due to rapid increase in size and the intra-abdominal swelling was noted to hyperechoic areas and heterogenicity and concerns of malignant lesions were raised and patient was promptly referred to pediatric hemato-oncologist who reviewed the ultrasound, examined the patient and concluded that the intra-abdominal mass is also a hemangioma and started the patient on a beta blocker (propranolol 2.3mg twice daily). Follow up exam shows that the swelling is now stabilized and patient had no side effects. She was hemodynamically stable.
Discussion: Hemangiomas are most common vascular tumors in infancy1 with increased occurance in female infants. Hemangiomas are clinically diagnosed and usually have a benign course and need no management as they regress with age. Visceral hemangiomas can be life threatening and may need imaging and liver being the common organ affected 1. Treatment is based on the nature, location, complications and rapidity of the growth interfering in normal functioning. Non-selective beta blocker(namely propranolol) has been used more commnly in the recent years and has had promising results2. Other treatment options are steroids, low-dose cyclophosphamide, interferon alpha, laser therapy and surgery in rare cases2. Our case stands out that despite it was a visceral hemangioma and the radiological findings of possible malignant changes, our patient responded well to treatment and had no associated complications. Rapidly enlarging hemangiomas can be concerning to parents and with further referrals and investigations could be challenging in infants.