Congenital Haemangiomas

Haemangiomas are benign (non-cancerous) collections of blood vessels. Unlike infantile haemangiomas which grow in the first few months of life, congenital haemangiomas are fully grown at birth.

• RICH or rapidly-involuting congenital haemangiomas undergo spontaneous decrease in size and colour over the first few years of life. They may leave behind residual pigmentation, some loose skin or a sunken area.
• NICH or non-involuting congenital haemangiomas do not undergo spontaneous resolution over time. They stay the same size or grow proportionally as the child grows. They are much less common than RICH.
• PICH or partially-involuting congenital haemangiomas undergo initial spontaneous decrease in size then stop shrinking, leaving a persistent birthmark.

What do congenital haemangiomas look like?

Congenital haemangiomas are round to oval shaped, pink to purplish swellings with overlying small blood vessels (telangiectasias). There may be a rim of pale skin at the outer edge of the lesion.

They can range in size from small 1 to 2cm lesions to large lesions measuring more than 10 to 20cm at birth.

They usually feel soft but sometimes, smaller harder lumps are felt within the lesion.

They feel warmer than the surrounding skin due to increased blood flow.

Congenital haemangiomas may also occur in the liver.

Congenital haemangioma

What cause congenital haemangiomas?

Congenital haemangiomas occur due to changes in genes called GNAQ or GNA11 that affect blood vessel development. These mutations are not inherited from parents and are not passed on to future children.

What problems can congenital haemangiomas cause?

Congenital haemangiomas are usually asymptomatic and do not cause any complications.

Occasionally, they can bleed or ulcerate especially at certain sites like the scalp and back. The bleeding can be severe and usually occurs in the first few weeks of life. If this occurs, direct pressure with a gauze or towel may help to stop bleeding. However, if bleeding persists or recurs, bring the child for medical attention.

In the newborn period, some babies with RICH may develop temporary low platelet counts (thrombocytopaenia), or rarely, heart problems due to increased blood flow through the birthmark. These issues typically resolve as the congenital haemangioma shrinks.

Large congenital haemangiomas may lead to cosmetic disfigurement and may require treatment. Large congenital haemangiomas in the liver may lead to heart failure as a lot of blood can be shunted from the heart to the haemangioma. Babies can present with shortness of breath or poor feeding when this occurs.

How are congenital haemangiomas diagnosed?

Congenital haemangiomas are diagnosed with a combination of clinical history, physical examination and tests including ultrasound, magnetic resonance imaging (MRI) and less commonly, tissue biopsies.

Ultrasound:

• A useful non-invasive, non-painful test.
• Aids in diagnosis, as well as helps to assess the suitability for treatment.
• Can be performed either in the clinic or at the diagnostic imaging centre.
• Involves using a probe placed on the skin over the site of the suspected lesion.
• Duration: a few minutes to 30 minutes, depending on the size of the congenital haemangioma; requires some cooperation from the child.

MRI:

• May also be utilised to aid the diagnosis and assess the extent of congenital haemangiomas
• No radiation involved.
• Duration: 30 to 60 minutes or longer (rare). The patient needs to remain completely still for the entire duration, which may be challenging for infants and young children. In such cases, general anaesthesia (GA) may be required, administered by our team of paediatric anaesthetists.

Tissue Biopsies:

• Rarely required.
• If required, this involves cutting the skin and removing a small piece of tissue to look under the microscope.
• May be done under local anaesthetic if the child is cooperative. Otherwise, it can also be performed under sedation in the ward or under GA in the operating theatre.

When to seek medical attention:

• Bleeding that doesn’t stop with gentle pressure
• Signs of infection (increased redness, warmth, pus or fever)
• Rapid changes in size or appearance
• Skin breakdown or ulceration
• Child appears to be in pain

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