Vascular Malformations and Hemangiomas

A hemangioma is a benign tumor caused by an overgrowth of the cells that line the blood vessels. A hemangioma initially appears as a small birthmark or scratch and affects one in every 2,000 newborns. Girls are three times more likely to develop hemangiomas than boys. About 60% of hemangiomas occur on the head or neck area, and 10% of affected babies have more than one hemangioma.

Hemangiomas typically grow quickly and often unpredictably. They all shrink eventually, but it can take up to seven years for a hemangioma to completely go away. 

Hemangiomas cause problems when located near the eyes, ears, nose or mouth. They may also present problems when located on a joint (may cause limitation in range of motion of the affected joint) or on areas of pressure points.

To stunt the growth of, shrink or remove a hemangioma, medication therapy with steroids or propranolol may be used, as well as vascular laser therapy, or in severe cases, surgery. We may potentially order an MRI scan to assess the possible involvement of blood vessels shared with other organs.

Examples of vascular malformations are port-wine stain (including Sturge-Weber syndrome) and cystic hygromas (lymphatic malformation). Sturge-Weber syndrome is a facial port-wine stain that can involve the brain and produce glaucoma or seizures. It needs to be evaluated closely by a pediatric plastic surgeon as well as a neurologist.

Lymphatic malformations can interfere with the body’s ability to remove bacteria from body tissues. Vascular malformations affect boys and girls at the same rate. Although present at birth, they may not be detected in utero.

Vascular anomalies do not go away without treatment and unfortunately do not respond to steroids, interferon or other medication therapies. Vascular laser treatments are excellent for treating vascular malformations. Because these grow throughout life, they require multiple treatments with the laser.

We frequently work with a pediatric radiologist to optimize the treatment of these lesions when surgery is required. We may order an MRI study and a special blood vessel study to evaluate the lymphangioma or vascular malformation prior to any therapy.

Prior to surgery, we will consult the interventional radiology unit for either percutaneous sclerotherapy or intravascular embolization, which decreases the size of the lesion and the amount of bleeding. Using a multidisciplinary approach reduces the number of surgeries needed and the amount of overall scaring.