Presentation
Preterm baby (28 weeks) with history of a hemangioma along the back of left shoulder. Now patient presented with bleeding and purulent discharge from the hemangioma.
Patient Data
A heterogeneous echogenicity lesion in the skin/superficial subcutaneous soft tissues, along the posterior aspect of the left shoulder joint (site of complain). The lesion shows high internal vascularity on color Doppler ultrasound examination.
A cutaneous lesion measuring approximately 1.8 x 3.0 x 3.5 cm is seen along the posterior aspect of the left shoulder joint. It shows high STIR and low T1 signal intensity with internal flow voids and avid enhancement on post-contrast sequences. The lesion shows some extension into the subcutaneous tissue with a linear abnormal signal seen reaching the deltoid muscle. The visualized osseous structures show normal morphology and signal intensity.
Histopathology report of the excised lesion confirming the diagnosis of infantile hemangioma.
Case Discussion
Preterm baby delivered at an average gestational age of 28 weeks. 1 x 1 cm size hemangioma was discovered along the posterior aspect of the left shoulder at the age of 3 weeks. It was initially observed clinically; however, due to progressive increase in its size at the age of two months, propranolol ointment 1% BID, was started after consultation with the dermatologist. At the age of 4 months, the baby was brought to the emergency department with bleeding and purulent discharge from the hemangioma. Imaging (US & MRI) was done and the imaging features were suggestive of a hemangioma.
Infantile hemangioma is the most frequent vascular tumor in children up to 1 year of age1. It is usually a clinical diagnosis, and imaging is often not required; however, imaging has a role in extensive and deep lesions and in the follow up during pharmacological treatment. The lesion has a classical clinical history; i.e. it is never present at birth, which is in contrast to the, congenital hemangioma, which is by definition already present at birth. Infantile hemangioma has two characteristic phases: a proliferative phase and an involutive phase1.
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