Congenital hemangiomas are benign vascular tumors of childhood that are present at birth. They are generally different from the much commoner infantile hemangioma on imaging and have distinct histological and clinical features.
While the majority are cutaneous or subcutaneous in nature, they can occur extra-cutaneously within various organs.
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Clinical presentation
Unlike the infantile form, congenital hemangiomas are fully formed lesions at birth which do not undergo significant growth. The majority then involute. Based on their location they can cause a range of symptoms due to the associated mass effect.
Classification
They are classed based on their subsequent clinical course.
slowly involuting congenital hemangioma (SICH) or partially involuting congenital hemangioma (PICH)
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non-involuting congenital hemangioma (NICH)
grows proportionately with the child
Pathology
Unlike infantile hemangiomas they do not exhibit the GLUT-1 transporter.
Radiographic features
Imaging appearances may overlap with infantile hemangiomas, but lesions are generally more heterogenous. In addition, the congenital form can also present with:
intravascular thrombi
larger venous components
vascular aneurysms
rarely poorly defined margins
Treatment and prognosis
Treatment can be considered if there are significant complications such as thrombocytopenia, significant vascular shunting with heart failure or anemia. Lesions which are in aesthetically relevant locations that may cause significant disfigurement can also be considered for treatment.
Medical therapy is usually ineffective. Of note, contrary to infantile hemangiomas, propranolol therapy is not an effective treatment of congenital hemangioma. Embolization or surgery can be considered for cases requiring treatment.
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