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Infantile Hemangiomas

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Infantile Hemangiomas Infantile Hemangiomas Denise Metry, M.D. Q1. Hemangioma development is most closely associated with: A. Trauma during delivery B. In-utero hypoxia C. Geography D. Maternal smoking E. Maternal ingestion of strawberries Q1. Hemangioma development is most closely associated with: A. Trauma during delivery B. In-utero hypoxia C. Geography D. Maternal smoking E. Maternal ingestion of strawberries Q2. On average, the majority of hemangioma involution is complete by what age? A. 2 years B. 4 years C. 7 years D. 10 years E. They never involute Q2. On average, the majority of hemangioma involution is complete by what age? A. 2 years B. 4 years C. 7 years D. 10 years E. Never Hemangioma Growth/Involution • 80% of growth occurs in first 3-4 months • 80% of involution occurs by kindergarten Question 3 Q3. The best treatment option for this infant is… A. Nothing B. Topical timolol C. Oral propranolol D. Laser E. Surgery Q3. The best treatment option for this infant is… A. Nothing B. Topical timolol C. Oral propranolol D. Laser E. Surgery Timolol 0.5% gel-forming solution Best candidate: Superficial, relatively flat hemangioma Cosmetically sensitive location Infant < 3 months of age Apply 1 drop BID-TID up to 12 months of age Risk of toxicity appears low Monitoring not generally required Oral Propranolol • Non-selective beta-blocker • MOA? • Baseline maternal and infant history, heart rate • 20 mg/5 ml solution. Start at 0.5 mg/kg/day ÷ tid or bid and increase by 25% every 4 days to 2 mg/kg/day • Generally well-tolerated but hypoglycemia real risk • Continued until 12 to 18 months of age Question 4 Q4. Which of the following is true re: hemangioma ulceration? A. Most often occurs during growth phase B. Usually painful C. Hemangioma often in a pressure-prone location D. Central whitening during rapid growth phase “red flag” E. All of the above Q4. Which of the following are true re: hemangioma ulceration? A. Most often occurs during growth phase B. Usually painful C. Hemangioma often in a pressure-prone location D. Central whitening during rapid growth phase “red flag” E. All of the above Ulceration Treatment • Wound care – Barrier ointment • Mupirocin oint, gentamycin oint, white petrolatum – Keep covered with non- stick dressing • Duoderm • Pain control – Acetaminophen, lidocaine 5% oint • Oral propranolol Question 5 Q5. True or False: This infant needs imaging of the spine. Q5. True or False: This infant needs imaging of the spine. Hemangiomas at-risk for tethered cord • Segmental • Span midline • Involve skin above gluteal crease • May have underlying lipoma • Dx = MRI Other Birthmarks Associated with Spinal Dysraphism High-Risk Low-Risk • Tuft of hair • Port-wine stain • Dimples (large, deep, > • Hyperpigmentation 2.5 cm from anal verge) • Nevi • Skin tags/tails • Small sacral dimples < 2.5 • Aplasia cutis or scar cm from anal verge Question 6 Q6. This infant is at-risk for which of the following syndromes? A. Sturge-Weber B. Klippel-Trenaunay-Weber C. Neonatal hemangiomatosis D. PHACE E. LUMBAR Q6. This infant is at-risk for which of the following syndromes? A. Sturge-Weber B. Klippel-Trenaunay-Weber C. Neonatal hemangiomatosis D. PHACE E. LUMBAR PHACE • Is a neurovascular and cardiovascular syndrome • Dx = head & neck MRI/A and ECHO • Varied severity spectrum with majority low-risk • Developmental delay most common sequela Question 7 Q7. The most likely diagnosis is: A. Infantile hemangioma B. Congenital “hemangioma” C. Kaposiform hemangio- endothelioma D. Venous malformation E. Infantile fibrosarcoma Q7. The most likely diagnosis is: A. Infantile hemangioma B. Congenital “hemangioma” C. Kaposiform hemangio- endothelioma D. Venous malformation E. Infantile fibrosarcoma Rapidly-involuting congenital “hemangioma” or RICH Thank you .
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