Congenital hemangiomas are benign vascular tumors of childhood that are present at birth. They are mostly indistinguishable from infantile hemangioma on imaging but have distinct histological and clinical features.
While the majority are cutaneous or subcutaneous in nature, they can occur extra-cutaneously within various organs. They are the commonest neonatal liver tumor (see infantile hepatic hemangioma).
Unlike the infantile form, congenital hemangiomas are fully formed lesions at birth which do not undergo significant growth. The majority then involute. Based on their location they can cause a range of symptoms due to the associated mass effect.
They are classed based on their subsequent clinical course.
- rapidly involuting congenital hemangioma (RICH)
- slowly involuting congenital hemangioma (SICH) or partially involuting congenital hemangioma (PICH)
- non-involuting congenital hemangioma (NICH)
- grows proportionately with the child
Unlike infantile hemangiomas they do not exhibit the GLUT-1 transporter.
Imaging appearances widely overlap with infantile hemangiomas. In addition the congenital form can also present with:
- intravascular thrombi
- larger venous components
- vascular aneurysms
- poorly defined margins
Treatment and prognosis
Treatment can be considered if there are significant complications such as thrombocytopenia, significant vascular shunting or anemia. Lesions which are in aesthetically relevant locations that may cause significant disfigurement can also be considered for treatment.
Medical therapy is usually tried first and includes corticosteroids, propranolol, vincristine and interferon. Embolization can be tried subsequently.