Definition

Infantile hemangioma (IH) are benign vascular

tumors that appear during the first months of
life characterized by a pattern of rapid
proliferation, followed by a slower period of
involution and are the most common pediatric
tumors.
 Epidemiologi
• The incidence of in the general population is
approximately 5%.
• F:M – ranging 3:2 to 5:1
• 10-12% white children involved
Lower in Asians and blacks
• Preterm infants, affecting 22% to 30% of
infants weighing less than 1 kg.
 Growth Characteristics

• Infantile hemangiomas proliferate during the first

2-3 months of life, with rapid growth of
superficial IH observed between 5-7 weeks of age
• Growth usually stabilizes around 4-6 months,
followed by involution over years
• Larger, deeper IH grow for longer and involute
more slowly.
• Based on these growth characteristics, IH
requiring intervention should be referred for
treatment before 3 months of age
 clinical appearance

• Hemangiomas may have superficial, deep or

mixed presentations
• Superficial hemangiomas are bright red and
minimally elevated, deep hemangiomas are
often larger with a bluish color. Mixed
hemangiomas have both components.
Superficial Deep Mixed
• Hemangiomas may occur anywhere on the
body
• They may be localized or segmental/regional
in distribution
• Regional/segmental IH of the head and neck
or lumbosacral areas may have underlying
structural anomalies (PHACE,
LUMBAR/SACRAL associations)
Natural history of segmental infantile hemangioma. Note the plaque-like, geographic
configuration. A. Age 11 months, peak of proliferating phase. B. Age 2 years, involuting
phase, apoptosis is maximal. C. Age 4 years, some further involution expected.
 Diagnosis
• Best diagnosed with thorough history and
physical examination.
• Generally not present at birth
• Cutaneous abnormality in form of pallor,
duskiness, telangiectasias.
• Bright red macule or papule rash with clear
boundaries
• Color may deepen with time
• 5 or more cutaneous hemangiomas
Recommend abdominal MRI (Liver)
 Congenital Hemangioma
• Hemangiomas that are fully formed tumors at the time
of birth and do not proliferate in postnatal life are
referred to as congenital hemangioma or congenital
nonprogressive hemangioma.
• 2 types
Rapidly involuting congenital hemangioma (RICH)
Non-involuting congenital hemangiomas (NICH)
• Difficult to distinguish
• GLUT-1 negative
• Medical therapy ineffective for RICH
• NICH may require laser or other surgical thera
Rapidly involuting congenital hemangioma
on left thigh. A. Note central ulceration,
violaceous color, and
pale periphery. Fast-flow vessels were
detected on Doppler examination
Noninvoluting congenital hemangioma
on right mandible. Note the overlying
telangiectasias and
rim of pallor.
 Tufted Angioma
• TA is a benign vascular tumor that has also been
called angioblastoma of Nakagawa.
• Its etiology and pathogenesis are uncertain.
• Unlike IH, there are no known gender or
gestational age correlates.
• More localized
• No skin involvement
• Dx with biopsy
• No standard treatment
Age 18 months. Tufted angioma (confirmed by biopsy) of the left leg,
buttocks, lower abdomen.
TAs display various clinical patterns. They may present as a subtle
stain-like area that later thickens, as a large, plaque-like, infiltrated,
red or dusky blue-purple lesion, or as an exophytic, firm, violaceous,
cutaneous nodule.
 Kasabach–Merritt phenomenon
• The KMP refers to the presence of platelet
trapping in the setting of vascular tumors
• It was long considered to be a complication of
“hemangioma,”
• it is now recognized to be a complication of TA
and KHE, not IH.
Kasabach–Merritt phenomenon secondary
to kaposiform hemangioendothelioma (KHE). An indurated,
purpuric tumor appeared at age 3 months and is seen here
at age 8 months. KHE confirmed by magnetic resonance
imaging and biopsy. Platelet count <5,000/mm3