Terminology regarding the vascular lesions of the soft tissues remains confusing. A single classification is necessary in order to decide on the proper investigation and the best treatment. At the Workshop on Vascular Anomalies in Rome in June 1996, the membership accepted the Mulliken and Glowacki classification, which differentiates vascular lesions into vascular tumors, including hemangiomas and vascular malformations. At Sainte-Justine, we have set up a multidisciplinary clinic for the discussion of problem patients with vascular anomalies, both in terms of diagnosis and treatment. In this review, we present our experience regarding the classification, the imaging modalities and the treatment of vascular anomalies. In our experience, Doppler ultrasound should be the initial imaging modality for recognizing vascular tumors from vascular malformations. CT scan or magnetic resonance imaging is best to evaluate the extent of the lesions prior to treatment. A multidisciplinary approach is essential to establish a correct diagnosis and define accordingly the appropriate treatment and follow-up.
OBJECTIVE. We describethe sonographic appearanceand vascularization of hemangio mas and determine if vessel density and peak systolic Doppler shifts distinguish hemangiomas from other superficial soft-tissue masses. SUBJECTSAND METHODS. Ourpilotstudyincluded 20 infants andchildren withhemangiomas who were to undergo biopsy before treatment with interferon alpha-2b. We used Doppler sonography to determine the number of vesselsper square centimeter, peak arterial Doppler shift, resistive index, and signs of arteriovenous shunting. All hemangiomas showed high vesseldensity (more than five per squarecentimeter) and high Doppler shifts (more than 2 kHz), and these two factors became our diagnostic criteria. A prospective study of I 16 pa tients was then carried out. One hundred sixteen consecutive pediatric patients with superficial soft-tissue masses were examined using Doppler sonography: sonographic findings were compared with the final diagnoses that were established by biopsy, CT, or clinical follow-up. and a peak arterial Doppler shift exceeding 2 kHz were correctly diagnosed as hemangiomas (sensitivity, 84%; specificity, 98%). One artenovenous malformation showed high vesselden sity and high Doppler shifts, but none of the other masses that were not hemangiomas did. RESULTS. The final diagnoses included70 hemangiomas, 20 venousmalformations,Eleven patients with hemangiomas who were being treated with interferon at the time of the study fulfilled only one of the two diagnostic criteria. CONCLUSION. Highvessel density andhighpeakarterial Dopplershiftcanbeusedtodistinguish hemangiomas from other soft-tissue masses.H emangiomas,which areamongthe most common soft-tissue tumors in infants [1â€"3), typically appearas slightly raised,bluish red subcutaneousmasses that resemblethe surface of a strawberry and regressasthe child grows older. Someheman giomasdo not havethis typical appearancebe cause part or all of the lesion is deep in the soft tissue and the overlying skin appears normal.These lesions are difficult to distinguish clini cally from more suspicioussoft-tissuemasses, such as vascularmalformations, soft-tissueUi mors (e.g., metastasesfrom neuroblastomaor rhabdomyosarcoma),and infantile myofibro matosis.Children with suchlesionsareusually referredfor imaging studies or biopsy.Blood flow in superficial vessels is readily discernible using Doppler sonography. We soughtto ascertainwhetherhemangiomashave characteristic features that can be seen using high-frequency gray-scale and Doppler sonog raphy and whether they can be distinguished from other superficial soft-tissuemassesin in fantsandchildren. Subjects and Methods PilotStudyTo determine the general appearanceand vascu
When investigating pelvic pathologic conditions in female pediatric patients, one needs to be aware of the developmental changes that take place around puberty. The prepubertal uterus is thin, with a fundus equal in size to the cervix. Owing to the hormonal stimulation of puberty, the uterus enlarges and the fundus becomes prominent. The ovaries are demonstrated with ultrasonography (US) at all ages. Ovarian volume increases after 6 years of age. Microcystic follicles are normally seen throughout childhood. US is the modality of choice for imaging the pediatric female pelvis. The main indications for pelvic US in the pediatric age group are pubertal precocity or pubertal delay, pelvic pain or pelvic masses, and ambiguous genitalia. Vaginal bleeding in the prepubertal child can be due to a vaginal foreign body, vaginal rhabdomyosarcoma, or precocious puberty. Common causes of primary amenorrhea in teenagers include gonadal dysgenesis (Turner syndrome) and müllerian (uterovaginal) anomalies. Pelvic pain or pelvic masses in pediatric patients can be due to ovarian torsion, hemorrhagic ovarian cyst, pelvic inflammatory disease, or ectopic pregnancy.
In pediatric patients, Doppler US is a noninvasive, easily available, and rapid mode of investigation of vascular lesions and can help confirm the diagnosis of VM when it shows a characteristic flow pattern.
Distinctive imaging characteristics are observed in cases of CH with US findings of visible vessels and calcifications statistically significant.
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