2015 HSC Section 1 Book of Articles

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

Figure 3 (a) Newborn with a round purple mass on the right thigh. Note that the skin has coarse telangiectasia, and that there is a peripheral pallor typical for CHs. (b) Same patient at 5 months of age. Note that the lesion has spontaneously involuted very rapidly, con fi rming that this is a RICH.

Figure 4 (a) A 4-year-old male patient with a raised, round lesion on the right shin since birth without regression. Note the coarse purple telangiectasia on the skin. (b) Axial T1-weighted image without fat saturation clearly demonstrates the in fi ltration of the skin, typical for CHs. (c) Axial contrast-enhanced T1-weighted image with fat saturation demonstrates avidly enhancing solid vascular mass with skin in fi ltration. Constellation of imaging fi ndings with patient ’ s age and no regression since presentation at birth makes the diagnosis of a NICH.

fl ow void within the IH noted in T2-weighted imaging represents the arterial feeder, an important diagnostic clue. DCE-MRA demonstrates early arterial enhancement in a soft-tissue mass with a draining vein. Typically, no perile- sional oedema is observed, which helps differentiation from other soft-tissue malignancies. Fibro-fatty in fi ltration can be observed during the involuting phase ( Fig 2 c e f). Congenital haemangioma Unlike IHs, CHs are fully formed at birth, with nearly no growth after birth, and lack positive staining with GLUT-1. Clinically, RICHs ( Figs 1 and 3 ) and NICHs ( Figs 1 and 4 ) appear similar, often presenting as violaceous grey tumours with prominent overlying veins or telangiectasias, which extend beyond the periphery of the lesion. Many have a

lighter or bluish halo on the surrounding skin. In practice, RICH and NICH are distinguished in retrospect, as the former involutes by 12 months of age, and the latter in- volutes either partially or not at all and requires surgical excision. RICH, too, can leave signi fi cant textural change necessitating reconstructive surgery after involution. 20 Early and accurate diagnosis is critical to avoid unnec- essary biopsy/surgical intervention. 21 Similar histological and clinical features of RICH and NICH raise the possibility that the latter may undergo involutional arrest to become a non-involuting tumour. 22 Kaposiform haemangioendothelioma KHE is a rare distinct vascular tumour, 23 which may present at birth or within the fi rst few months of life as an

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