The learning objectives of this exhibit are:
To review the imaging features of pediatric hepatic hemangiomas (HHs) across multiple imaging modalities, including ultrasound, CEUS, CT and MRI
To review the hemodynamic changes associated with HHs
To learn the specific imaging features of HHs intertwined with a macroscopic vascular shunt
To illustrate different evolution patterns of HHs
Hemangiomas are the most common benign neonatal vascular tumor. They are caused by abnormal proliferation of vascular endothelial cells. They most commonly affect the skin, but can occur in nearly any organ.
Cutaneous hemangiomas have been categorized into two types based on their clinical and histological features: infantile and congenital. Infantile hemangiomas appear within the first few weeks of life, progressively enlarge over months and then involute. They stain positive for GLUT1. In contrast, congenital hemangiomas are fully grown at birth and do not usually...
Findings and procedure details
On US, HHs can present with a spectrum of imaging findings, showing variable size, echogenicity, and tumor vascularity. Lesions can appear predominantly hyperechoic, hypoechoic, isoechoic, targetoid, or as large dilated cystic vascular spaces (Fig. 9, 11). On color Doppler US, the intensity of tumor vascularity can be mild (small focal areas of color signal), moderate (large focal areas of weak color signal), or marked (diffuse color signal) (Fig. 10). They may show increased stiffness on US elastography.
Pediatric HHs present with diverse imaging findings. Knowledge of their different imaging presentations and evolution patterns will help in making an accurate diagnosis and guide disease management.
Personal information and conflict of interest
C. M. Rutten:
Nothing to disclose
Nothing to disclose
Mulliken J, Enjolras O. Congenital hemangiomas and infantile hemangioma: missing links. J Am Acad Dermatol.2004 Jun;50(6):875-82.
Nasseri E, Piram M, McCuaig CC, et al. Partially involuting congenital hemangiomas: a report of 8 cases and review of the literature. J Am Acad Dermatol. 2014 Jan;70(1):75-9.
Christison-Lagay ER, Burrows PE, Alomari A, et al. Hepatic hemangiomas: subtype classification and development of a clinical practice algorithm and registry. J Pediatr Surg. 2007;42(1):62-68.
Grassia, KL,Peterman, CM,Iacobas, I, et al.Clinical case series of pediatric hepatic angiosarcoma.Pediatr Blood Cancer.2017;64:e26627.