3.2.6 Hemangioma

Grading & Level of Importance: B




Infantile haemangioma, strawberry nevus, hemangioma of infancy (HI).


Relatively frequent (4-5% of infants).


Benign vascular tumours that appear in the first weeks after birth.

Aetiology & Pathogenesis

Unknown but has been discussed.

Signs & Symptoms

Dome-shaped circumscribed bright red nodules (cutaneous haemangioma), or pink to blue soft swelling (subcutaneous haemangioma), or both (mixed type) or superficial.


They can be located in any area of the body.


Superficial (cutaneous), deep (subcutaneous) or mixed (superficial and deep).

Laboratory & other workups

Laboratory tests are not needed.


Histology is not needed for the diagnosis. A proliferation of dermal mature vessels without inflammatory infiltrate is observed if a biopsy is performed. However, growing HI express more GLU-1 receptor by immunohistochemistry. This should prompt the clinician to  consider intervention.


Childhood haemangiomas are not present at birth, appear in the first weeks of life, grow during a few months and then spontaneously regress in the first or first years of life. Those which are rapidly and continuously growing need intervention.

Clinical presentation


Ulceration (infection, pain), scar with esthetic consequences, bleeding (uncommon). Depending on hemangioma location:

Eye: amblyopia

Nose: cartilage deformation 

Lips: feeding difficulties 

Lower jaw: associated subglottic hemangioma with possible stridor and respiratory obstruction

Segmentary facial hemangiomas and perineal/lombo-sacral hemangiomas may be associated with underlying malformations (rare); miliary hemangiomatosis may be associated with visceral hemangiomas and high output cardiac insufficiency (rare).


Most cases: clinical. Diagnostic uncertainty: ultrasonography. Suspicious subglottic hemangioma: referral to ENT (ear-nose-throat) specialist. Suspicious PHACES or PELVIS syndrome: brain or medullary MRI, respectively. Glut-1 staining.

Differential diagnosis

Differential diagnoses include vascular malformations (such as: nevus flammeus), granuloma pyogenicum, angiosarcoma, other malignant tumors (rhabdomyosarcoma, infantile fibrosarcoma). Kasabach-Merritt syndrome is characterized by profound thrombocytopenia, consumptive coagulopathy with a hemorrhagic risk, in association with vascular tumors (rare).

Prevention & Therapy

In most cases: no treatment. In case of complications related to localization or rapid growth: beta-blockers (propranolol).


Aggressive early treatment (laser) may be needed in fast growing lesions in anatomical risky localisations (i.e. eyes), however, in this situation, systemic ß-blocker administration as an inpatient may be required.

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