Diagnosis Of Infantile Hemangiomas Research Articles

Effects of Propranolol on Neurodevelopmental Outcomes in Patients with Infantile Hemangioma: A Case-Control Study.

Background The aim of this study was to examine whether oral propranolol has any effect on neurodevelopment outcomes in young children with problematic infantile hemangiomas (IHs). Methods Thirty-six children with a diagnosis of problematic IH who were treated with oral propranolol were compared with 34 healthy children with no history of propranolol therapy. Patients received propranolol therapy for at least 3 months. Gesell developmental schedules (GDS) were used to evaluate neurodevelopment outcomes in the two groups. The scores of each GDS domain were compared between the two groups. Results There were no significant differences in developmental quotient (DQ) values for any of the five domains between the patients and healthy controls (P < 0.05). Multiple stepwise regression analyses showed that none of the domains in the control group were influenced by the children's gender or age (P < 0.05). In addition, we found that gender, age at the initiation of therapy, age at the time of the neurodevelopment test, and treatment duration had no effect on any domain of the GDS in the patient group (P > 0.05). Conclusion Propranolol has no obvious effect on neurodevelopmental outcomes in children. Early treatment and treatment duration had no negative effect on central nervous system (CNS) development.

Role of imaging in the diagnosis of parotid infantile hemangiomas

ObjectivesTo review the clinical presentation, imaging and follow-up of parotid infantile hemangiomas (IH). MethodsOver a 15-year period, all patients with a clinical diagnosis of parotid IH were evaluated. Imaging was available in 35. The medical records, photographs, and radiology studies of these patients were reviewed. ResultsAll patients presented at less than 4 months of age (M:F, 13:21). 19 (55)% of tumors were on the left and were bilateral in 2 patients. The majority (29 patients) presented due to localized swelling or palpable mass; the remainder had a cutaneous lesion, but no palpable mass at the time of presentation. The referring diagnosis was incomplete or incorrect in 9 patients (26%).The imaging studies all demonstrated a well-defined homogeneous mass, with no abnormality of the surrounding subcutaneous fat. Sonography showed a uniformly vascular lesion with pulsatile fast-flow seen on Doppler. On MRI, the lesion was hyperintense on T2-weighted images, isointense on T1, with intense enhancement post-contrast.Oral therapy (propranolol or corticosteroids) was prescribed in 15 (45%). Follow-up in 28 patients demonstrated stability of the lesion in 11, regression in size in 11 and complete involution in 6. After involution 2 patients underwent resection of residual tissue and/or excess skin. ConclusionsTypical clinical presentation alone may be adequate to establish a diagnosis of parotid infantile hemangioma. However, in patients with no overlying cutaneous lesion, imaging can play a critical role in confirming the diagnosis. The sonographic findings are sufficiently characteristic to allow for a definitive diagnosis, obviating the need for further investigations. If diagnostic uncertainty remains or the full extent of the lesion cannot be appreciated, then MRI should be preferred over CT to avoid ionizing radiation.

Increasing incidence of infantile hemangiomas (IH) over the past 35 years: Correlation with decreasing gestational age at birth and birth weight

Infantile hemangiomas (IH) are the most common soft-tissue tumors of infancy, but little is known regarding their true incidence. We sought to determine the current incidence of IH and examine trends in incidence, demographics, and lesion characteristics over 3decades. The Rochester Epidemiology Project was used to identify infants residing in Olmsted County, Minnesota, who were given a diagnosis of IH between January 1, 1976, and December 31, 2010. In all, 999 infants were given a diagnosis of IH. Incidence increased over the 3-decade study period from 0.97 to 1.97 per 100 person-years (P<.001). Average gestational age at birth and birth weight for infants with IH decreased over the study period (39.2-38.3weeks, P<.001 and 3383-3185g, P=.003, respectively). The overall age- and sex-adjusted incidence of IH was 1.64 per 100 person-years (95% confidence interval 1.54-1.75). The population of Olmsted County, Minnesota, is predominantly non-Hispanic white, limiting our ability to report racial differences in incidence. This was a retrospective study. This study provides a longitudinal, population-based incidence of IH. Incidence has increased steadily over the past 3decades, correlating significantly with decreasing gestational age at birth and birth weight in affected infants.

Surgical Management of Scalp Infantile Hemangiomas.

Scalp infantile hemangiomas (IHs) are usually focal lesions that can be both disfiguring and may lead to complications such as ulceration and bleeding. The clinical features of scalp IHs have not been previously studied. This study aims to identify the clinical characteristics associated with scalp IH, the indications for surgical intervention, and results of surgical treatment. We performed a retrospective chart review of patients with scalp IH presenting to a tertiary care referral center over the past 7 years. Patients' demographics, clinical features, location, and treatment course were noted. One hundred fifty-one of 1916 total IH patients presented with a diagnosis of scalp IH (8%). The distribution of the scalp lesions was the following: 31.8% frontal, 46.7% parietal, 7.9% occipital, and 9.9% temporal. Fifty-eight percent were solitary and 42% were multifocal lesions. The size range of scalp IH is 1 × 1 cm to 8 × 6 cm. Two percent of patients with scalp IH presented with other facial IH. Primary indications for surgery were secondary to complications such as ulceration (23.2%) and alopecia (51.7%). Surgery included elliptical excision with primary closure (85.7%) or with rotational flap closure (14.3%). The average age of surgery was 3 years (1-8 years). Most patients had a good aesthetic outcome with satisfactory hair growth. Scalp IHs are morbid tumors which often cause alopecia and/or ulceration. In our experience, many scalp IHs eventually require surgical intervention. We find that early surgical excision is beneficial, as the tissues are easily manipulated secondary to scalp/soft tissue laxity and scarring is more favorable.

Color Doppler Ultrasound Follow-Up of Infantile Hemangiomas and Peripheral Vascularity in Patients Treated with Propranolol.

Infantile hemangiomas (IHs) are the most common vascular tumors in childhood. Diagnosis of IHs is usually clinical, however, to determine the actual dimensions of the lesion or the anatomic changes that occur during its evolution and treatment, a color Doppler ultrasound (CDU) examination can be performed. To date, there are few publications that assess the sonographic response to propranolol in IHs, and to our knowledge, none that consider simultaneous evaluation of both intralesional and normal peripheral blood vessels in these cases. Evaluation of the anatomic effect of propranolol in IHs and peripheral blood vessels using CDU. A cohort study was performed in 10 pediatric patients with a diagnosis of IH in whom systemic therapy with propranolol was indicated. The patients underwent a baseline and 3-month follow-up CDUs of the tumor and the main peripheral vessels of the right upper extremity. The group was composed of 7 (70%) girls and 3 (30%) boys. The average CDU decrease in size of the longitudinal axis was 11%; of the transverse axis, 24%; tumor thickness, 30%; and intralesional vessel thickness, 46%. Hemangioma volume measured by CDU decreased an average of 51%. The thickness of the peripheral vessels did not change significantly between the baseline and 3-month follow-up CDUs. CDU permits noninvasive quantification of the changes in IHs and peripheral vessels in patients receiving propranolol therapy. In our cohort of cases there was a significant reduction in tumor volume; however, peripheral vascularity was not significantly affected.

Effectiveness of propranolol in the treatment of infantile hemangioma beyond the proliferation phase.

During the last 5 years, many studies have shown the efficacy of propranolol as first-line treatment for infantile hemangiomas (IHs), but not much has been written about the role of propranolol beyond the proliferation phase of IH (>1 year). Our aim was to assess propranolol efficacy and safety in the treatment of patients older than 1 year. A retrospective study of patients older than 1 year diagnosed with IH and treated in our vascular anomalies clinic between 2009 and 2013 was performed. Eighteen patients older than 1 year with a diagnosis of IH (15 girls, 3 boys) were identified. The mean age at the time of initiation of treatment was 25.7 months (range 13-72 mos). Single lesions were observed in 13 patients and multiple lesions in 5. Fifteen patients had focal lesions and three had segmental. The median duration of treatment with oral propranolol was 11.8 months (range 2-33 mos). Complete response was observed in 72.2% of the patients and partial response in 27.8%. Recurrence was observed in three patients 4.7 months after completion of therapy (range 0.3-8 mos). These patients required further therapy with propranolol for 6 more months. Bradycardia was documented in two patients and night terrors in one patient, which led to discontinuation of treatment. In our experience, propranolol may be useful in the treatment of IHs beyond the proliferation phase (>1 year old), but more studies are needed to support this observation.