Diagnosis of Hemangiomas

Abstract

Diagnosis of hemangiomas is based first on the medical history. The presence of a lesion at birth supports a diagnosis of a vascular malformation or congenital hemangioma. Infantile hemangiomas are characterized by an initial rapid proliferation phase in the first 6–9 months of life, followed by a slow involution phase and, in many cases, complete regression. Physical examination should allow a hemangioma to be classified as superficial, deep, or mixed type. On imaging, Doppler ultrasound (US) can assess the flow dynamics of a hemangioma, but the most important tool is contrast-enhanced magnetic resonance imaging (MRI), which demonstrates the extent of the lesion and can help to differentiate between a hemangioma and another disorder. The type of lesion can usually be determined based on the physical examination and Doppler US. MRI is mostly useful for confirming the clinical diagnosis, estimating the extent of the lesion, and determining the feasibility of surgical resection. If the diagnosis is in question after a thorough history, physical examination and radiological findings, a skin biopsy can be helpful in distinguishing unusual or atypical hemangiomas from other vascular lesions.