Infantile hemangioma

Case contributed by Dennis Odhiambo Agolah
Diagnosis almost certain


Posterior neck swelling since birth. Clinically, bluish to purplish soft swelling with faint pulsations on touch.

Patient Data

Age: 21 days old
Gender: Female

An expansile, soft and oval-shaped solid lesion with heterogeneous parenchymal echogenicity, intrinsic multifocal soft non-shadowing phleboliths, plus diffuse hypervascularity on color and power Doppler interrogation.

The lesion is subcutaneous in location at the posterior neck medially and exhibits multiple feeder vessels, including pulsating arterial and monophasic venous flows. These features are representative of a focal, highly vascularized infantile hemangioma.

Case Discussion

Infantile hemangiomas sonographically have variable morphological pictograms. In this case, diffuse anechoic intralesional linear areas (which masqueraded initially before color/power flow Doppler as cystic spaces), actually turned out as multiple centripetally and perifocally distributed chaotic vascular supply, with organized feeder vessels from the inferior lesional region.

Multiple hyperechoic calcific foci of micro-millimeter diameters with reverberation artifacts are scattered within the lesional parenchyma.

Other plausible differentials in this case may include:

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