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==Overview==
==Overview==
A hemangioma is an abnormal build up of blood vessels in the skin or internal organs.<ref>{{cite web | url = http://www.nlm.nih.gov/medlineplus/ency/article/001459.htm | title = ''Hemangioma''| authro [Michael S. Lehrer, M.D., Department of Dermatology, University of Pennsylvania Medical Center, Philadelphia, PA. Review provided by VeriMed Healthcare Network.]}}</ref> It is also described as a congenital benign skin lesion consisting of dense, usually elevated masses of dilated [[blood vessels]]".<ref>{{cite web | url = http://www.kmle.com/search.php?Search=hemangioma | title = ''KMLE American Heritage Medical Dictionary definition of hemangioma'' | author = [http://www.kmle.com The American Heritage Stedman's Medical Dictionary]}}</ref> In most cases, hemangiomas will disappear over time.  They are formed either during [[gestation]] or appear during the first few weeks of life and may present as a [[birthmark]]. Hemangiomas can be vivid superficial [[lesions]], known as capillary hemangiomas (often referred to as "Strawberry Marks"), or they can be deep bluish swelling, known as cavernous hemangiomas. Sometimes they can be both superficial and deep. Approximately eighty percent are located on the face and neck, with the next most prevalent location being the [[liver]]. Although hemangiomas are [[benign]], some serious complications can occur.
'''Hemangioma''' was first described by Dr. Robert Liston, a British surgeon, in 1843.<ref name=History>Liston R. Case of erectile tumour in the popliteal space.-Removal. Med Chir Trans. 1843;26:120-32.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2116921/pdf/medcht00056-0152.pdf</ref> Hemangioma may be classified according to International Society for the Study of Vascular Anomalies into six subtypes: Infantile hemangioma, congenital hemangioma, tufted angioma, spindle-cell hemangioma, epithelioid hemangioma, and lobular capillary hemangioma.<ref name=hemangioma>Hemangioma. Dr Tim Luijkx and Dr Donna D'Souza et al. Radiopaedia (2015). http://radiopaedia.org/articles/haemangioma. Accessed on November 12, 2015</ref><ref name="RichterFriedman2012">{{cite journal|last1=Richter|first1=Gresham T.|last2=Friedman|first2=Adva B.|title=Hemangiomas and Vascular Malformations: Current Theory and Management|journal=International Journal of Pediatrics|volume=2012|year=2012|pages=1–10|issn=1687-9740|doi=10.1155/2012/645678}}</ref> Development of hemangioma is the result of genetic mutations, overexpression of angiogenic fators and downregulation of inhibitors of angiogenesis.<ref name="PapafragkakisMoehlen2011">{{cite journal|last1=Papafragkakis|first1=Haris|last2=Moehlen|first2=Martin|last3=Garcia-Buitrago|first3=Monica T.|last4=Madrazo|first4=Beatrice|last5=Island|first5=Eddie|last6=Martin|first6=Paul|title=A Case of a Ruptured Sclerosing Liver Hemangioma|journal=International Journal of Hepatology|volume=2011|year=2011|pages=1–5|issn=2090-3456|doi=10.4061/2011/942360}}</ref> Hemangioma may be associated with [[POEMS syndrome]] and [[Castleman disease]]. On gross pathology, spongy with vascular compartments of various sizes separated by fibrous tissue are findings of hemangioma.<ref name="PapafragkakisMoehlen2011">{{cite journal|last1=Papafragkakis|first1=Haris|last2=Moehlen|first2=Martin|last3=Garcia-Buitrago|first3=Monica T.|last4=Madrazo|first4=Beatrice|last5=Island|first5=Eddie|last6=Martin|first6=Paul|title=A Case of a Ruptured Sclerosing Liver Hemangioma|journal=International Journal of Hepatology|volume=2011|year=2011|pages=1–5|issn=2090-3456|doi=10.4061/2011/942360}}</ref> On microscopic histopathological analysis, channels lined by benign endothelium containing red blood cells are findings of hemangioma.<ref name=Librepathology>Microscopic features of hemangioma. Librepathology (2015). http://librepathology.org/wiki/index.php/Hemangioma. Accessed on November 12, 2015</ref> There are no established causes for hemangioma.<ref name=epidemiology>Zheng JW, Zhang L, Zhou Q, et al. A practical guide to treatment of infantile hemangiomas of the head and neck. Int J Clin Exp Med. 2013;6(10):851-60.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3832322/?report=classic#</ref> Hemangioma must be differentiated from other diseases such as: Congenital hemangioma, [[Hemangioendothelioma|kaposiform hemangioendothelioma]], tufted angioma, and [[Port-wine stain|nevus flammeus]], and [[pyogenic granuloma]].<ref name="CallahanYoon2012">{{cite journal|last1=Callahan|first1=Alison B.|last2=Yoon|first2=Michael K.|title=Infantile hemangiomas: A review|journal=Saudi Journal of Ophthalmology|volume=26|issue=3|year=2012|pages=283–291|issn=13194534|doi=10.1016/j.sjopt.2012.05.004}}</ref> The prevalence of infantile hemangioma is estimated to be up to 10% in general population.<ref name="RichterFriedman2012">{{cite journal|last1=Richter|first1=Gresham T.|last2=Friedman|first2=Adva B.|title=Hemangiomas and Vascular Malformations: Current Theory and Management|journal=International Journal of Pediatrics|volume=2012|year=2012|pages=1–10|issn=1687-9740|doi=10.1155/2012/645678}}</ref> Hemangioma commonly affects infants.<ref name=epidemiology>Zheng JW, Zhang L, Zhou Q, et al. A practical guide to treatment of infantile hemangiomas of the head and neck. Int J Clin Exp Med. 2013;6(10):851-60.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3832322/?report=classic#</ref> Females are more commonly affected with hemangioma than males.<ref name=epidemiology>Zheng JW, Zhang L, Zhou Q, et al. A practical guide to treatment of infantile hemangiomas of the head and neck. Int J Clin Exp Med. 2013;6(10):851-60.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3832322/?report=classic#</ref> Common risk factors in the development of hemangioma are [[female]] gender, [[prematurity]], [[low birth weight]], and fair skin.<ref name="RichterFriedman2012">{{cite journal|last1=Richter|first1=Gresham T.|last2=Friedman|first2=Adva B.|title=Hemangiomas and Vascular Malformations: Current Theory and Management|journal=International Journal of Pediatrics|volume=2012|year=2012|pages=1–10|issn=1687-9740|doi=10.1155/2012/645678}}</ref> According to the United States Preventive Services Task Force, there is insufficient evidence to recommend routine screening for hemangioma.<ref name=USPSTF>Hemangioma. USPSTF. http://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=hemangioma Accessed on November 10, 2015</ref> If left untreated, 20% of patients with hemangioma may progress to develop [[ulceration]], [[hemorrhage]], [[infection]], and [[High output failure|high output cardiac failure]].<ref name="HassanShreef2014">{{cite journal|last1=Hassan|first1=Basheir A.|last2=Shreef|first2=Khalid S.|title=Propranolol in Treatment of Huge and Complicated Infantile Hemangiomas in Egyptian Children|journal=Dermatology Research and Practice|volume=2014|year=2014|pages=1–5|issn=1687-6105|doi=10.1155/2014/541810}}</ref> Common complications of hemangioma include [[ischemia]], [[necrosis]], [[ulceration]], and [[bleeding]].<ref name="RichterFriedman2012">{{cite journal|last1=Richter|first1=Gresham T.|last2=Friedman|first2=Adva B.|title=Hemangiomas and Vascular Malformations: Current Theory and Management|journal=International Journal of Pediatrics|volume=2012|year=2012|pages=1–10|issn=1687-9740|doi=10.1155/2012/645678}}</ref> Prognosis is generally good. Physical examination findings of superficial hemangioma include well-demarcated, flat, and erythematous red patches.<ref name="RichterFriedman2012">{{cite journal|last1=Richter|first1=Gresham T.|last2=Friedman|first2=Adva B.|title=Hemangiomas and Vascular Malformations: Current Theory and Management|journal=International Journal of Pediatrics|volume=2012|year=2012|pages=1–10|issn=1687-9740|doi=10.1155/2012/645678}}</ref> The majority of cases of hemangioma are self-limited. Patients with small, stable hemangiomas in non-vital sites are treated with "wait and see" approach, whereas patients with fast growth of hemangioma are treated medically.<ref name=epidemiology>Zheng JW, Zhang L, Zhou Q, et al. A practical guide to treatment of infantile hemangiomas of the head and neck. Int J Clin Exp Med. 2013;6(10):851-60.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3832322/?report=classic#</ref> Surgery is not the first-line treatment option for patients with hemangioma. It is usually reserved for patients with either massive protuberant proliferating hemangioma and lesions that are refractory to less invasive treatments.<ref name="CallahanYoon2012">{{cite journal|last1=Callahan|first1=Alison B.|last2=Yoon|first2=Michael K.|title=Infantile hemangiomas: A review|journal=Saudi Journal of Ophthalmology|volume=26|issue=3|year=2012|pages=283–291|issn=13194534|doi=10.1016/j.sjopt.2012.05.004}}</ref><ref name="RichterFriedman2012">{{cite journal|last1=Richter|first1=Gresham T.|last2=Friedman|first2=Adva B.|title=Hemangiomas and Vascular Malformations: Current Theory and Management|journal=International Journal of Pediatrics|volume=2012|year=2012|pages=1–10|issn=1687-9740|doi=10.1155/2012/645678}}</ref>
==Historical Perspective==
==Historical Perspective==
Hemangioma was first described by Dr. Robert Liston, a British surgeon, in 1843.<ref name=History>Liston R. Case of erectile tumour in the popliteal space.-Removal. Med Chir Trans. 1843;26:120-32.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2116921/pdf/medcht00056-0152.pdf</ref>
Hemangioma was first described by Dr. Robert Liston, a British surgeon, in 1843.<ref name=History>Liston R. Case of erectile tumour in the popliteal space.-Removal. Med Chir Trans. 1843;26:120-32.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2116921/pdf/medcht00056-0152.pdf</ref>
==Classification==
==Classification==
Hemangioma may be classified according to International Society for the Study of Vascular Anomalies into six subtypes: infantile hemangioma, congenital hemangioma, tufted angioma, spindle-cell hemangioma, epithelioid hemangioma, and lobular capillary hemangioma.<ref name=hemangioma>Hemangioma. Dr Tim Luijkx and Dr Donna D'Souza et al. Radiopaedia (2015). http://radiopaedia.org/articles/haemangioma. Accessed on November 12, 2015</ref><ref name="RichterFriedman2012">{{cite journal|last1=Richter|first1=Gresham T.|last2=Friedman|first2=Adva B.|title=Hemangiomas and Vascular Malformations: Current Theory and Management|journal=International Journal of Pediatrics|volume=2012|year=2012|pages=1–10|issn=1687-9740|doi=10.1155/2012/645678}}</ref>
Hemangioma may be classified according to International Society for the Study of Vascular Anomalies into six subtypes: Infantile hemangioma, congenital hemangioma, tufted angioma, spindle-cell hemangioma, epithelioid hemangioma, and lobular capillary hemangioma.<ref name=hemangioma>Hemangioma. Dr Tim Luijkx and Dr Donna D'Souza et al. Radiopaedia (2015). http://radiopaedia.org/articles/haemangioma. Accessed on November 12, 2015</ref><ref name="RichterFriedman2012">{{cite journal|last1=Richter|first1=Gresham T.|last2=Friedman|first2=Adva B.|title=Hemangiomas and Vascular Malformations: Current Theory and Management|journal=International Journal of Pediatrics|volume=2012|year=2012|pages=1–10|issn=1687-9740|doi=10.1155/2012/645678}}</ref>
==Pathophysiology==
==Pathophysiology==
Development of hemangioma is the result of genetic mutations, overexpression of angiogenic fators and downregulation of inhibitors of angiogenesis.<ref name="PapafragkakisMoehlen2011">{{cite journal|last1=Papafragkakis|first1=Haris|last2=Moehlen|first2=Martin|last3=Garcia-Buitrago|first3=Monica T.|last4=Madrazo|first4=Beatrice|last5=Island|first5=Eddie|last6=Martin|first6=Paul|title=A Case of a Ruptured Sclerosing Liver Hemangioma|journal=International Journal of Hepatology|volume=2011|year=2011|pages=1–5|issn=2090-3456|doi=10.4061/2011/942360}}</ref> Hemangioma may be associated with [[POEMS syndrome]] and [[Castleman disease]]. On gross pathology, spongy with vascular compartments of various sizes separated by fibrous tissue are findings of hemangioma.<ref name="PapafragkakisMoehlen2011">{{cite journal|last1=Papafragkakis|first1=Haris|last2=Moehlen|first2=Martin|last3=Garcia-Buitrago|first3=Monica T.|last4=Madrazo|first4=Beatrice|last5=Island|first5=Eddie|last6=Martin|first6=Paul|title=A Case of a Ruptured Sclerosing Liver Hemangioma|journal=International Journal of Hepatology|volume=2011|year=2011|pages=1–5|issn=2090-3456|doi=10.4061/2011/942360}}</ref> On microscopic histopathological analysis, channels lined by benign endothelium containing red blood cells are findings of hemangioma.<ref name=Librepathology>Microscopic features of hemangioma. Librepathology (2015). http://librepathology.org/wiki/index.php/Hemangioma. Accessed on November 12, 2015</ref>
==Causes==
==Causes==
There are no established causes for hemangioma.<ref name=epidemiology>Zheng JW, Zhang L, Zhou Q, et al. A practical guide to treatment of infantile hemangiomas of the head and neck. Int J Clin Exp Med. 2013;6(10):851-60.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3832322/?report=classic#</ref>
==Differentiating Hemangioma from other Diseases==
==Differentiating Hemangioma from other Diseases==
Hemangioma must be differentiated from other diseases such as: congenital hemangioma, kaposiform hemangioendothelioma, tufted angioma, and nevus flammeus.<ref name="CallahanYoon2012">{{cite journal|last1=Callahan|first1=Alison B.|last2=Yoon|first2=Michael K.|title=Infantile hemangiomas: A review|journal=Saudi Journal of Ophthalmology|volume=26|issue=3|year=2012|pages=283–291|issn=13194534|doi=10.1016/j.sjopt.2012.05.004}}</ref>
Hemangioma must be differentiated from other diseases such as: Congenital hemangioma, [[Hemangioendothelioma|kaposiform hemangioendothelioma]], tufted angioma, and [[Port-wine stain|nevus flammeus]], and [[pyogenic granuloma]].<ref name="CallahanYoon2012">{{cite journal|last1=Callahan|first1=Alison B.|last2=Yoon|first2=Michael K.|title=Infantile hemangiomas: A review|journal=Saudi Journal of Ophthalmology|volume=26|issue=3|year=2012|pages=283–291|issn=13194534|doi=10.1016/j.sjopt.2012.05.004}}</ref>
==Epidemiology and Demographics==The prevalence of infantile hemangioma is estimated to be upto 10% in general population.<ref name="RichterFriedman2012">{{cite journal|last1=Richter|first1=Gresham T.|last2=Friedman|first2=Adva B.|title=Hemangiomas and Vascular Malformations: Current Theory and Management|journal=International Journal of Pediatrics|volume=2012|year=2012|pages=1–10|issn=1687-9740|doi=10.1155/2012/645678}}</ref> Hemangioma commonly affects infants.<ref name=epidemiology>Zheng JW, Zhang L, Zhou Q, et al. A practical guide to treatment of infantile hemangiomas of the head and neck. Int J Clin Exp Med. 2013;6(10):851-60.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3832322/?report=classic#</ref> Females are more commonly affected with hemangioma than males.<ref name=epidemiology>Zheng JW, Zhang L, Zhou Q, et al. A practical guide to treatment of infantile hemangiomas of the head and neck. Int J Clin Exp Med. 2013;6(10):851-60.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3832322/?report=classic#</ref>
==Epidemiology and Demographics==
The prevalence of infantile hemangioma is estimated to be up to 10% in general population.<ref name="RichterFriedman2012">{{cite journal|last1=Richter|first1=Gresham T.|last2=Friedman|first2=Adva B.|title=Hemangiomas and Vascular Malformations: Current Theory and Management|journal=International Journal of Pediatrics|volume=2012|year=2012|pages=1–10|issn=1687-9740|doi=10.1155/2012/645678}}</ref> Hemangioma commonly affects infants.<ref name=epidemiology>Zheng JW, Zhang L, Zhou Q, et al. A practical guide to treatment of infantile hemangiomas of the head and neck. Int J Clin Exp Med. 2013;6(10):851-60.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3832322/?report=classic#</ref> Females are more commonly affected with hemangioma than males.<ref name=epidemiology>Zheng JW, Zhang L, Zhou Q, et al. A practical guide to treatment of infantile hemangiomas of the head and neck. Int J Clin Exp Med. 2013;6(10):851-60.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3832322/?report=classic#</ref>
==Risk Factors==
==Risk Factors==
Common risk factors in the development of hemangioma are [[female]] gender, [[prematurity]], [[low birth weight]], and fair skin.<ref name="RichterFriedman2012">{{cite journal|last1=Richter|first1=Gresham T.|last2=Friedman|first2=Adva B.|title=Hemangiomas and Vascular Malformations: Current Theory and Management|journal=International Journal of Pediatrics|volume=2012|year=2012|pages=1–10|issn=1687-9740|doi=10.1155/2012/645678}}</ref>
==Screening==
==Screening==
According to the United States Preventive Services Task Force, there is insufficient evidence to recommend routine screening for hemangioma.<ref name=USPSTF>Hemangioma. USPSTF. http://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=hemangioma</ref>
According to the United States Preventive Services Task Force, there is insufficient evidence to recommend routine screening for hemangioma.<ref name=USPSTF>Hemangioma. USPSTF. http://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=hemangioma Accessed on November 10, 2015</ref>
==Natural History, Complications and Prognosis==
==Natural History, Complications and Prognosis==
If left untreated, 20% of patients with hemangioma may progress to develop [[ulceration]], [[hemorrhage]], [[infection]], and [[High output failure|high output cardiac failure]].<ref name="HassanShreef2014">{{cite journal|last1=Hassan|first1=Basheir A.|last2=Shreef|first2=Khalid S.|title=Propranolol in Treatment of Huge and Complicated Infantile Hemangiomas in Egyptian Children|journal=Dermatology Research and Practice|volume=2014|year=2014|pages=1–5|issn=1687-6105|doi=10.1155/2014/541810}}</ref> Common complications of hemangioma include [[ischemia]], [[necrosis]], [[ulceration]], and [[bleeding]].<ref name="RichterFriedman2012">{{cite journal|last1=Richter|first1=Gresham T.|last2=Friedman|first2=Adva B.|title=Hemangiomas and Vascular Malformations: Current Theory and Management|journal=International Journal of Pediatrics|volume=2012|year=2012|pages=1–10|issn=1687-9740|doi=10.1155/2012/645678}}</ref> Prognosis is generally good.
==Diagnosis==
==Diagnosis==
==Staging==
There is no established system for the staging of hemangioma.
===History and symptoms===
===History and symptoms===
Symptoms of hemangioma include: flat, and erythematous red patches.<ref name="RichterFriedman2012">{{cite journal|last1=Richter|first1=Gresham T.|last2=Friedman|first2=Adva B.|title=Hemangiomas and Vascular Malformations: Current Theory and Management|journal=International Journal of Pediatrics|volume=2012|year=2012|pages=1–10|issn=1687-9740|doi=10.1155/2012/645678}}</ref>
===Physical Examination===
===Physical Examination===
Physical examination findings of superficial hemangioma include well-demarcated, flat, and erythematous red patches.<ref name="RichterFriedman2012">{{cite journal|last1=Richter|first1=Gresham T.|last2=Friedman|first2=Adva B.|title=Hemangiomas and Vascular Malformations: Current Theory and Management|journal=International Journal of Pediatrics|volume=2012|year=2012|pages=1–10|issn=1687-9740|doi=10.1155/2012/645678}}</ref>
===Laboratory Findings===
===Laboratory Findings===
There are no diagnostic lab findings associated with hemangioma.
===CT===
===CT===
On [[CT scan]], [[hepatic hemangioma|hemangioma of the liver]] is characterized by dynamic enhancement pattern related to the size of its vascular space.<ref name=hemangioma>Differential diagnosis of hepatic hemangioma. Dr Yuranga Weerakkody et al. Radiopaedia (2015). http://radiopaedia.org/articles/hepatic-haemangioma-3. Accessed on October 26, 2015</ref>
===MRI===
===MRI===
===Ultrasound===
===Ultrasound===
===Other Imaging Findings===
Ultrasound may be helpful in the diagnosis of hemangioma. Findings on ultrasound suggestive of hemangioma include fat, phleboliths or prominent vascular channels.<ref name=Ultrasound>Ultrasound of Facial hemangioma. Dr Sinéad Culleton. Radiopaedia (2015). http://radiopaedia.org/cases/facial-haemangioma. Accessed on November 17, 2015</ref>
===Other Diagnostic Studies===
==Treatment==
==Treatment==
===Medical therapy===
===Medical therapy===
 
The majority of cases of hemangioma are self-limited. Patients with small, stable hemangiomas in non-vital sites are treated with "wait and see" approach, whereas patients with fast growth of hemangioma are treated medically.<ref name=epidemiology>Zheng JW, Zhang L, Zhou Q, et al. A practical guide to treatment of infantile hemangiomas of the head and neck. Int J Clin Exp Med. 2013;6(10):851-60.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3832322/?report=classic#</ref>
===Surgery===
===Surgery===
Surgery is not the first-line treatment option for patients with hemangioma. It is usually reserved for patients with either massive protuberant proliferating hemangioma and lesions that are refractory to less invasive treatments.<ref name="CallahanYoon2012">{{cite journal|last1=Callahan|first1=Alison B.|last2=Yoon|first2=Michael K.|title=Infantile hemangiomas: A review|journal=Saudi Journal of Ophthalmology|volume=26|issue=3|year=2012|pages=283–291|issn=13194534|doi=10.1016/j.sjopt.2012.05.004}}</ref><ref name="RichterFriedman2012">{{cite journal|last1=Richter|first1=Gresham T.|last2=Friedman|first2=Adva B.|title=Hemangiomas and Vascular Malformations: Current Theory and Management|journal=International Journal of Pediatrics|volume=2012|year=2012|pages=1–10|issn=1687-9740|doi=10.1155/2012/645678}}</ref>
===Primary Prevention===
===Primary Prevention===
There are no primary or secondary preventive measures available for hemangioma.
==References==
==References==
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{{Reflist|2}}
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Latest revision as of 22:01, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Hemangioma was first described by Dr. Robert Liston, a British surgeon, in 1843.[1] Hemangioma may be classified according to International Society for the Study of Vascular Anomalies into six subtypes: Infantile hemangioma, congenital hemangioma, tufted angioma, spindle-cell hemangioma, epithelioid hemangioma, and lobular capillary hemangioma.[2][3] Development of hemangioma is the result of genetic mutations, overexpression of angiogenic fators and downregulation of inhibitors of angiogenesis.[4] Hemangioma may be associated with POEMS syndrome and Castleman disease. On gross pathology, spongy with vascular compartments of various sizes separated by fibrous tissue are findings of hemangioma.[4] On microscopic histopathological analysis, channels lined by benign endothelium containing red blood cells are findings of hemangioma.[5] There are no established causes for hemangioma.[6] Hemangioma must be differentiated from other diseases such as: Congenital hemangioma, kaposiform hemangioendothelioma, tufted angioma, and nevus flammeus, and pyogenic granuloma.[7] The prevalence of infantile hemangioma is estimated to be up to 10% in general population.[3] Hemangioma commonly affects infants.[6] Females are more commonly affected with hemangioma than males.[6] Common risk factors in the development of hemangioma are female gender, prematurity, low birth weight, and fair skin.[3] According to the United States Preventive Services Task Force, there is insufficient evidence to recommend routine screening for hemangioma.[8] If left untreated, 20% of patients with hemangioma may progress to develop ulceration, hemorrhage, infection, and high output cardiac failure.[9] Common complications of hemangioma include ischemia, necrosis, ulceration, and bleeding.[3] Prognosis is generally good. Physical examination findings of superficial hemangioma include well-demarcated, flat, and erythematous red patches.[3] The majority of cases of hemangioma are self-limited. Patients with small, stable hemangiomas in non-vital sites are treated with "wait and see" approach, whereas patients with fast growth of hemangioma are treated medically.[6] Surgery is not the first-line treatment option for patients with hemangioma. It is usually reserved for patients with either massive protuberant proliferating hemangioma and lesions that are refractory to less invasive treatments.[7][3]

Historical Perspective

Hemangioma was first described by Dr. Robert Liston, a British surgeon, in 1843.[1]

Classification

Hemangioma may be classified according to International Society for the Study of Vascular Anomalies into six subtypes: Infantile hemangioma, congenital hemangioma, tufted angioma, spindle-cell hemangioma, epithelioid hemangioma, and lobular capillary hemangioma.[2][3]

Pathophysiology

Development of hemangioma is the result of genetic mutations, overexpression of angiogenic fators and downregulation of inhibitors of angiogenesis.[4] Hemangioma may be associated with POEMS syndrome and Castleman disease. On gross pathology, spongy with vascular compartments of various sizes separated by fibrous tissue are findings of hemangioma.[4] On microscopic histopathological analysis, channels lined by benign endothelium containing red blood cells are findings of hemangioma.[5]

Causes

There are no established causes for hemangioma.[6]

Differentiating Hemangioma from other Diseases

Hemangioma must be differentiated from other diseases such as: Congenital hemangioma, kaposiform hemangioendothelioma, tufted angioma, and nevus flammeus, and pyogenic granuloma.[7]

Epidemiology and Demographics

The prevalence of infantile hemangioma is estimated to be up to 10% in general population.[3] Hemangioma commonly affects infants.[6] Females are more commonly affected with hemangioma than males.[6]

Risk Factors

Common risk factors in the development of hemangioma are female gender, prematurity, low birth weight, and fair skin.[3]

Screening

According to the United States Preventive Services Task Force, there is insufficient evidence to recommend routine screening for hemangioma.[8]

Natural History, Complications and Prognosis

If left untreated, 20% of patients with hemangioma may progress to develop ulceration, hemorrhage, infection, and high output cardiac failure.[9] Common complications of hemangioma include ischemia, necrosis, ulceration, and bleeding.[3] Prognosis is generally good.

Diagnosis

Staging

There is no established system for the staging of hemangioma.

History and symptoms

Symptoms of hemangioma include: flat, and erythematous red patches.[3]

Physical Examination

Physical examination findings of superficial hemangioma include well-demarcated, flat, and erythematous red patches.[3]

Laboratory Findings

There are no diagnostic lab findings associated with hemangioma.

CT

On CT scan, hemangioma of the liver is characterized by dynamic enhancement pattern related to the size of its vascular space.[2]

MRI

Ultrasound

Ultrasound may be helpful in the diagnosis of hemangioma. Findings on ultrasound suggestive of hemangioma include fat, phleboliths or prominent vascular channels.[10]

Treatment

Medical therapy

The majority of cases of hemangioma are self-limited. Patients with small, stable hemangiomas in non-vital sites are treated with "wait and see" approach, whereas patients with fast growth of hemangioma are treated medically.[6]

Surgery

Surgery is not the first-line treatment option for patients with hemangioma. It is usually reserved for patients with either massive protuberant proliferating hemangioma and lesions that are refractory to less invasive treatments.[7][3]

Primary Prevention

There are no primary or secondary preventive measures available for hemangioma.

References

  1. 1.0 1.1 Liston R. Case of erectile tumour in the popliteal space.-Removal. Med Chir Trans. 1843;26:120-32.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2116921/pdf/medcht00056-0152.pdf
  2. 2.0 2.1 2.2 Hemangioma. Dr Tim Luijkx and Dr Donna D'Souza et al. Radiopaedia (2015). http://radiopaedia.org/articles/haemangioma. Accessed on November 12, 2015
  3. 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 3.11 3.12 Richter, Gresham T.; Friedman, Adva B. (2012). "Hemangiomas and Vascular Malformations: Current Theory and Management". International Journal of Pediatrics. 2012: 1–10. doi:10.1155/2012/645678. ISSN 1687-9740.
  4. 4.0 4.1 4.2 4.3 Papafragkakis, Haris; Moehlen, Martin; Garcia-Buitrago, Monica T.; Madrazo, Beatrice; Island, Eddie; Martin, Paul (2011). "A Case of a Ruptured Sclerosing Liver Hemangioma". International Journal of Hepatology. 2011: 1–5. doi:10.4061/2011/942360. ISSN 2090-3456.
  5. 5.0 5.1 Microscopic features of hemangioma. Librepathology (2015). http://librepathology.org/wiki/index.php/Hemangioma. Accessed on November 12, 2015
  6. 6.0 6.1 6.2 6.3 6.4 6.5 6.6 6.7 Zheng JW, Zhang L, Zhou Q, et al. A practical guide to treatment of infantile hemangiomas of the head and neck. Int J Clin Exp Med. 2013;6(10):851-60.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3832322/?report=classic#
  7. 7.0 7.1 7.2 7.3 Callahan, Alison B.; Yoon, Michael K. (2012). "Infantile hemangiomas: A review". Saudi Journal of Ophthalmology. 26 (3): 283–291. doi:10.1016/j.sjopt.2012.05.004. ISSN 1319-4534.
  8. 8.0 8.1 Hemangioma. USPSTF. http://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=hemangioma Accessed on November 10, 2015
  9. 9.0 9.1 Hassan, Basheir A.; Shreef, Khalid S. (2014). "Propranolol in Treatment of Huge and Complicated Infantile Hemangiomas in Egyptian Children". Dermatology Research and Practice. 2014: 1–5. doi:10.1155/2014/541810. ISSN 1687-6105.
  10. Ultrasound of Facial hemangioma. Dr Sinéad Culleton. Radiopaedia (2015). http://radiopaedia.org/cases/facial-haemangioma. Accessed on November 17, 2015

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