Expert Treatment Referrals

filled blisteres may develop on top of the skin and may Hematologists: Hematologists help to address the possibly weep. The size of lymphatic malformations potential bleeding disorders which may go along with may change with infection and/or trauma that results in the child’s vascular anomaly or its treatment. These bleeding into the malformation, and increased lymph physicians help to follow blood counts and to make flow through the region. Lymphatic malformations recommendations regarding possible therapies. often may be treated with a special procedure that is done by an interventional radiologist; this involves the Otolaryngologists: Vascular malformations often injection of a medicine into the lymph vessel to help may involve the airway. ENT surgeons help to make decrease the flow. Following this therapy, surgery recommendations regarding the management of the to decrease the size of the malformation often is an airway and the surgical intervention that might be option. For lymphatic mal­formations of the arms and needed to remove compromising lesions. legs, compression garments may provide a benefit. Pathologists: Pathologists help to diagnose the lesion Arterial malformations often appear as a combined after it is biopsied or removed. They can provide arterial-venous malfor­mation. The lesion is usually critical information that helps in ongoing treatment. purple with a palpable fullness beneath the skin. Often Pediatricians: The team’s pediatricians help to warmth and vibrations can be felt from the high blood monitor the child in terms of his or her growth and flow. Unfortunately, arterial malformations can cause development. Sometimes children with vascular pain, bleeding, and ulceration for which treatment is anomalies are on steroids and propranolol and the required. Arterial malformations are often pre-surgically pediatricians help to monitor the side effects of this treated with a special radiology procedure to decrease medication. flow in the vessels; this is done by an interventional radiologist, and surgical removal follows. Pediatric Surgeons: Vascular lesions may present in many locations on the body. If a child has an anomaly Expert Treatment that extends internally, these surgeons help in The specialists at planning and executing the treatment. Children’s Hospital’s Vascular Anomalies Center Plastic Surgeons: Plastic Surgeons help to treat the are trained to address all vascular anomalies using techniques such as laser aspects of your child’s and staged excision. They utilize various methods for diagnosis, treatment, and reconstruction if needed. recovery. Management of vascular anomalies Radiologists: The interventional radiologist uses includes a variety of minimally invasive techniques to help assess the health care professionals because the skills of many extent and exact nature of a complex vascular lesion. different specialties are needed to help treat each The interventional radiologist can provide procedures www.chp.edu aspect of the problem depending on the severity of which can be used adjunctively to other treatments. the lesion. The team’s specialists include the following: They also can therapeutically treat certain lesions. Vascular Anomalies Center at Dermatologists: Dermatologists help to diagnose Referrals Children’s Hospital of Pittsburgh of UPMC vascular malformations as well as to help formulate Pediatricians, primary care physicians, obstetricians, 4401 Penn Avenue a treatment plan. They often help in executing parts and other health professionals, as well as parents and Pittsburgh, PA 15224 A coordinated team approach of the treatment in coordination with the rest of the patients can make referrals to the Vascular Anomalies to vascular anomalies in infants, team. 412-692-8942 Center. Contact the team coordinator at 412-692-8942. children, and adolescents

CL/MT 10-030 What are vascular anomalies? Hemangiomas that are large, ulcerated, distort facial Vascular anomalies are birthmarks of the skin that structures (eye or nose), or involve the airway, are often are made up of various kinds of blood vessels and are treated with a course of oral steroids or propranolol. characterized by shades of red or purple. They may be raised or flat. These birthmarks are classified into two Who are more vulnerable to major groups: hemangiomas? n Preterm infants are much more likely to have n Hemangiomas (or vascular tumors that grow) hemangiomas with an incidence of about 23 percent. When your child is typically appear shortly after birth, undergo born with a birth- a period of rapid growth, and shrink during n There is a 3 to 5:1 ratio of females to males affected. vascular malformation mark or vascular childhood n They are seen in approximately 10 to 12 percent of malformation, n Vascular malformations are usually present Caucasians (1 in 300). the specialists at in the newborn and “grow” with the infant. What are vascular malformations and Children’s Hospital Sometimes they actually expand (with infection, puberty, or pregnancy). how are they treated? of Pittsburgh of UPMC can provide a Vascular malformations are named based on the type coordinated team approach to his or The differentiation of a of vessel that makes up the lesion. There are capillary, her vascular anomaly. hemangioma from a vascular arterial, venous, and lymphatic malformations. Some­ malfor­mation is made by a times, vascular malformations occur as combined Our specialists are trained to care for thorough history and physical lesions, such as in Klippel-Trenaunay Syndrome children with a wide spectrum of birth- exam. Rarely is a radiographic (lymphatic, venous, and capillary malformation). capillary malformation marks, including hemangiomas and the study or biopsy needed to help in the diagnosis. Capillary malformations, previously referred to as complications that accompany them, port-wine stains, appear as flat pink or red stains on as well as vascular malfor­mations, which What are hemangiomas and how are they the skin. They are present at birth and typically remain can be made up of veins, arteries, treated? throughout life (often becoming wart like in nature) capillaries, and lymph vessels. unless they are treated. Pulsed dye laser therapy often Hemangiomas are the most common birthmark of is effective at removing or lightening the discoloration. infancy. This is best done in infancy and often requires multiple What should you expect during your n The lesion is usually seen at about 2 weeks of life. treatments spaced several months apart. initial visit to the Center? n Typically it manifests as a pink to light red area on During your initial visit to the center, you will meet Venous malformations may affect the skin, muscle, the superficial skin. venous malformation with a coordinator who will be your primary contact and bone. They often appear as soft, easily compressive n during the course of treatment. The coordinator The growth phase starts around 2 months of age masses that have a blue tint. They often enlarge when determines which specialists are best suited to meet and the lesion grows rapidly and becomes red placed in a dependent position. As the child grows, your child’s needs. Once the team is identified, they and raised until about age 1 when it then begins the malformation grows with them. The venous will perform a complete evaluation of your child in to shrink. malformation often can be pre-surgically treated order to make a clear diagnosis and develop a n Deeper lesions may appear purple in color with with a special radiology procedure that decreases treatment plan. The findings and treatment will be the skin being less raised. the venous flow; this is done by an interventional radiologist. Surgery is another option for certain communicated to you and the referring physicians n Hemangiomas shrink approximately 50 percent by venous malformations. during and after the visit. age 5 and nearly 70 percent by age 7.

The team coordinator is an excellent resource for you Visually, the lesions typically fade in color and the skin Lymphatic malformations have been referred to as lymphatic malformation and your child. He or she can answer questions, make takes on a “crepe-paper” look. When the lesions fade cystic hygromas. They often involve the underlying appointments, and coordinate any necessary and shrink, approx­imately 50 percent of children muscle and/or bone and may cause swelling and bony diagnostic testing. have normal appearing skin. overgrowth. Occasionally, clusters of very small fluid-