2015 HSC Section 1 Book of Articles

A. Tekes et al. / Clinical Radiology 69 (2014) 443 e 457

IH often is not apparent at birth and most appear in the fi rst 6 weeks of life as a soft, non-compressible mass with a typical triphasic evolution: proliferation, plateau, and involution. Super fi cial haemangiomas are generally cherry red macules and papules; deep haemangiomas are reasonably fi rm subcutaneous masses sometimes with a bluish skin hue. Compound haemangiomas obviously combine aspects of both types. Most IHs double in size in the fi rst 2 months of life, and approximately 80% reach their maximum size between by 6 months of age. 12 Spontaneous regression over the fi rst several years of life is typical 13,14 ; however, up to 40% of IHs may have residual skin changes and fi bro-fatty residuum, especially in the head and neck region. IHs within the cutaneous lumbosa- cral region can be associated with tethered cord. In patients with large IHs in the head and neck region there may be

concern for airway compromise, ulceration, or bleeding, which can be medically treated, with propranolol as the leading choice of medication ( Figs 1 and 2 a e b). The immunohistochemical marker, glucose transporter protein isoform 1 (GLUT1) has become a major tool in the diagnosis of IH, with the endothelial cells staining strongly. The overwhelming majority of other VTs do not stain pos- itive for GLUT-1. 15,16 Imaging is not required for the majority of IHs but can be useful to con fi rm the suspected diagnosis in atypical lesions and to determine the extent of deep lesions and to exclude other VTs (such as KHE), or soft-tissue malignancies. US demonstrates a solid mass with increased colour fl ow within the mass. 17 Arterial feeder and venous drainage can be visualized using Doppler US. 18 MRI reveals a T2 bright, T1 isointense mass with homo- geneous, avid contrast enhancement. 19 Internal serpiginous

Figure 1 SEMVAFC. IH, Infantile haemangioma; RICH, Rapidly involuting congenital haemangioma; NICH, non-involuting congenital hae- mangioma; KHE, Kaposiform haemangioendothelioma; VM, Venous malformation; LM, Lymphatic malformation; AVM, Arteriovenous malfor- mation; KT, Klippel e Trenaunay.

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