Prenatal diagnosis of rapidly involuting congenital hemangioma: a case report and review of the literature

Abstract

Congenital hemangiomata are rare benign vascular tumors, presenting as fully mature lesions at birth. Three types have been described; the “rapidly involuting congenital hemangioma” (RICH), the “non-involuting congenital hemangioma” (NICH)and the “partially involuting congenital hemangioma” (PICH). We herein report on a RICH type congenital hemangioma, identified during a fetal morphology ultrasound performed at 19 weeks’ gestation. Early diagnosis allowed close surveillance of the fetus and neonate and observation of the natural course of this lesion. Although being a potentially life-threatening condition, no intervention was required. It presented as a 4 cm vascular tumor on the forehead at time of the cesarean section and diminished rapidly over the first 4 neonatal months, resulting in some skin excess and discoloration which is expected to entirely resolve by 14 months of age.

Prenatal Diagnosis of a Facial Teratoma. A Proposed Approach to Diagnose Prenatal Facial Anomalies

“…A nasal glioma 11 might thereby present at a later stage with loss of its intracranial connection and closure of the bone. A teratoma, [3][4][5] osteoma, 13,14 hamartoma 15 or haemangioma 16 can occur anywhere on the face, and a teratoma [3][4][5] can thereby displace the surrounding structures. A dacrocystocele 17 is found at the medial inner canthus.…”

“…Hamartoma 15,28 Usually benign, focal disorganized overgrowth of mature mesenchymal tissue Solid soft-tissue mass, cystic components; homo-or heterogeneous; can contain calcifications; isoechoic to surrounding soft-tissue; echogenic fibrovascular stalk, sessile; single vascular pedicle; depending on the location, orbital or intracranial extension can occur; both solitary and multiple. Haemangioma 16 Proliferation of endothelial cells lining the blood vessels Vascular, mixed echogenicity; Rapidly involuting congenital hemangioma (RICH, fast-growing) or non-involuting congenital hemangioma (NICH, not usually a prenatal diagnosis). Dacrocystocele 17 Nasolacrimal duct obstruction, due to obstruction of the valve of Hasner Cystic; hypo-, anechoic; avascular; circular or tubular; arising from the medial epicanthus.…”

“…A rapidly involuting congenital haemangioma is expected to spontaneously regress; a non-involuting congenital haemangioma and partially -involuting congenital haemangioma on the other hand will warrant a surgical approach. 16 A small simple ranula/ mucocele 19,20 can resolve itself, while larger ones are usually excised/marsupialized. Alternatively, laser and cryotherapy both have been described as well in this context.…”