Introduction:
Congenital hemangioma is an uncommon but not rare vascular lesion that is completely developed at the time of birth, grows during pregnancy, and can be diagnosed during prenatal scanning, males and females are equally affected, if the lesion grows as the child grows it is called proportional growth and a type of congenital hemangioma called non-involuting congenital hemangioma (NICH) undergoes proportional growth. It is different from infantile hemangioma which is very common, appears as a small scratch or bruise at birth and rapidly grows for about an average of 8 months of age, females are affected most, most of them are not visible during birth and start to develop around the first four to six weeks of life.
What Is Congenital Hemangioma?
Congenital hemangioma is a type of vascular lesion that acts as a birthmark and occurs due to the growth of blood vessels that are tangled under the skin. Therefore this is present at birth and is fully developed. These can be diagnosed during prenatal ultrasound scanning.
What Are the Features of Congenital Hemangioma?
The features of congenital hemangioma are:
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It can equally occur in females and males.
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They are less common than infantile hemangioma (a benign vascular lesion that grows after birth and is fully developed after four to six weeks of birth).
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They are oval or round and are pink to blue along with pale-colored skin around them.
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They can be as big as around 10 centimeters.
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Most of them are found on the superficial surface of the skin. They can also appear on the liver.
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They are made up of thin-walled blood vessels and with the help of ultrasound, the flow of blood vessels can be high or low.
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They do not increase in size or grow after birth, some of them can even shrink.
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The area is raised above the skin lesion.
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The surface may look waxy and may have thread veins called telangiectasia.
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They have a slightly raised temperature than the rest of the body, due to increased blood vessels.
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They mostly appear on the neck, head, and limbs of the body.
What Are the Types of Congenital Hemangioma?
There are three types of congenital hemangioma which are:
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Rapidly Involuting Congenital Hemangioma (RICH): This type of congenital hemangioma shrinks, undergoes a rapid regression phase and mostly disappears around 12 to 24 months of age. It requires no treatment, but sometimes surgery is needed to remove the loose skin or scarring. RICH can undergo some amount of proportional growth before shrinkage.
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Non-involuting Congenital Hemangioma (NICH): This type of congenital hemangioma does not undergo shrinkage. These are present at birth and may grow as the child grows. A surgical procedure is required to remove the lesion and if it is large, it may require embolization (a procedure to reduce the blood flow with the help of small gelatin beads or sponges to block the blood vessels) before the removal of the lesion. NICH undergoes proportional growth until the child grows.
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Partially Involuting Congenital Hemangioma (PICH): This type of congenital hemangioma has areas that undergo shrinkage and other areas that do not.
What Is the Cause of Congenital Hemangioma?
The cause of congenital hemangioma is unknown and research is still going on. Risk factors or genetic factors are also not found but, congenital hemangiomas may run in families.
What Is the Diagnosis of Congenital Hemangioma?
Congenital hemangiomas are visible at birth and can be diagnosed using ultrasound. The diagnosis of congenital hemangioma includes:
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Ultrasound Scanning: This diagnostic method uses high-frequency sound waves to read the image and helps in understanding the blood flow of the hemangioma.
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Magnetic Resonance Imaging (MRI): It is a non-invasive diagnostic procedure that can produce three-dimensional images. It can provide information on blood flow, size, and connection to other blood vessels or organs. The lesion has a heterogeneous appearance in MRI.
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Biopsy: Biopsy is a diagnostic procedure in which a piece of tissue is removed and studied under a microscope. This helps identify the type of hemangioma. The features under the microscope are:
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It has a solid appearance with poorly formed vessels. A combination of vascular and solid areas can be seen.
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NICH has a rapid growth phase and contains mitotically active endothelium (inner lining of a blood vessel). Well-formed capillaries and vascular channels are seen.
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Pericyte (cells which are present on the walls of capillaries) layer is present.
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What Is the Treatment of Congenital Hemangioma?
The treatment for congenital hemangioma includes:
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Watchful Waiting: To assess if the lesion undergoes shrinkage. Rapidly involuting congenital hemangioma does not require any treatment since they undergo shrinkage and disappear around one to one and half years of age. But the skin which has undergone shrinkage may become loose and may undergo lipoatrophy (loss of fat subcutaneously) which may require treatment with laser surgery, plastic surgery, or fat transfer.
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Surgical Excision: Congenital hemangiomas that continue to grow, become ulcerated, or harm the heart should be surgically removed.
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Ligation: If the hemangioma is large and has a lot of blood supply, which can result in loss of blood during excision, the main blood vessels near it are ligated to avoid loss of blood.
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Embolization: A procedure that is used to reduce the blood flow with the help of small gelatin beads or sponges to block the blood vessels with the help of a catheter (a thin long tube) which is placed in the blood vessel.
What Are the Complications of Congenital Hemangioma?
The complications of congenital hemangioma are:
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Ulceration (breakdown of the skin) of the hemangioma.
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Bleeding from the lesion.
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Continued growth.
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Heart problems are rare and occur due to the high flow of blood to the lesion, therefore increasing the load on the heart.
Conclusion:
Therefore congenital hemangiomas are fully grown at birth and NICH has growth potential and grows as the baby grows and requires surgical excision. After the surgical excision of the hemangioma, the lesion is unlikely to recur. Newborns with congenital hemangioma do not have any risk for health conditions.
