Angiographic features of rapidly involuting congenital hemangioma (RICH)

Abstract

Rapidly involuting congenital hemangioma (RICH) is a recently recognized entity in which the vascular tumor is fully developed at birth and undergoes rapid involution. Angiographic findings in two infants with congenital hemangioma are reported and compared with a more common postnatal infantile hemangioma and a congenital infantile fibrosarcoma. Congenital hemangiomas differed from infantile hemangiomas angiographically by inhomogeneous parenchymal staining, large and irregular feeding arteries in disorganized patterns, arterial aneurysms, direct arteriovenous shunts, and intravascular thrombi. Both infants had clinical evidence of a high-output cardiac failure and intralesional bleeding. This congenital high-flow vascular tumor is difficult to distinguish angiographically from arteriovenous malformation and congenital infantile fibrosarcoma.

Reticular Infantile Hemangioma of the Limb Can Be Associated with Ventral‐Caudal Anomalies, Refractory Ulceration, and Cardiac Overload

“…Also, rare vascular tumors that arise in utero may be detected prenatally, present fully grown at birth, and are known as congenital hemangiomas (6). These are divided into two major subgroups: those that exhibit accelerated regression, called rapidly involuting congenital hemangioma (RICH) (7–9), and those that fail to regress, called noninvoluting congenital hemangioma (NICH) (10). Curiously, these two types of congenital hemangioma are more common in the extremities than in the head and neck, do not exhibit a female preponderance, and fail to immunostain for GLUT1 (9).…”

Congenital enormous high flow capillary hemangioma of forearm

“…1,2 It is known that hemangiomas that proliferate in utero and present as congenital masses, may involute much earlier in infancy. 1 In fact, an uncommon variety of congenital hemangioma with rapid involution called rapidly involuting congenital hemangioma(RICH) 3 presents as a large mass at birth, as in this patient. However, in RICH the arterial vascular supply is disorganized with small aneurysms and the contrast staining of the mass is not homogeneous.…”

Hemangiomas of Head and Neck - A Review

“…Doppler shows arterial or venous waveforms with high vessel density >5 vessels / cm 2 24,25 . Angiography of RICH demonstrates a well circumscribed areas with an intense tissue staining in a lobular pattern with enlarged surrounding systemic artery branches 26 .…”