Congenital hemangioma

What is a congenital hemangioma?

A congenital hemangioma (hem-an-gee-o-ma) is a vascular lesion that is present and fully grown at birth. Doctors may diagnose a congenital hemangioma on a prenatal ultrasound.

Before the year 2000, these lesions were grouped in with infantile hemangiomas. We now understand that congenital hemangiomas look very different under the microscope and behave very differently than infantile hemangiomas.

Congenital hemangiomas:

  • Are most often found in the skin and are usually superficial (close to the surface of the skin). They also can be found in the liver.
  • Are made up of thin-walled, low- to high-flow blood vessels. (Doctors can see these vessels using ultrasound technology).
  • Do not grow after birth and some may even shrink.
  • Occur equally in males and females.
  • Are much less common than infantile hemangiomas.

What does a congenital hemangioma look like?

  • They are usually round or oval.
  • They are pink to blue in color with pale-colored skin (pallor) around them.
  • The involved area is raised above the skin.
  • They feel warmer to the touch than the rest of the body. 
  • Congenital hemangiomas most often appear on the head, neck or limbs of the body.
congenital hemangiomas knee

Noninvoluting congenital hemangioma

What are the types of congenital hemangiomas?

Congenital hemangiomas can be broken down into two categories:

  • Noninvoluting congenital hemangioma
  • Rapidly involuting congenital hemangioma

Noninvoluting congenital hemangiomas (NICH)

The characteristics of this type of congenital hemangioma are:

  • They are present at birth and grow as your child grows.
  • They do not go through a regression (shrinking) phase.

Treatment options for NICH

A NICH may be surgically removed. If the NICH is large, a radiologist may need to perform an embolization procedure prior to surgery to help control the bleeding. Embolization helps decrease the blood flow to a vascular lesion in order to reduce blood loss during surgery.

congenital hemangiomas bruise

Rapidly Involuting Congenital Hemangioma

Rapidly involuting congenital hemangiomas (RICH)

RICHs also are present at birth. However, they go through a rapid regression phase and may be completely gone by the time your child is 12 to 18 months old. Surgery may be necessary even after regression of the tumor to reduce loose skin or scarring.

What causes a congenital hemangioma?

There is no known cause of congenital hemangiomas. Children's Hospital of Wisconsin is doing research to find causes of vascular malformations and tumors, including congenital hemangiomas.

Treatment options for congenital hemangiomas

Treatment options for your child will depend upon the size, type and location of the lesion.

  • Watchful waiting. If your child’s lesion is shrinking, the doctor may choose observation instead of treatment.
  • Surgery. Surgery to remove the lesion is the best option if there are complications such as skin breakdown and bleeding. Your child’s doctor may consult a cardiologist before surgery if the lesion is very large and has significant blood flow through it.
    Although there are several effective topical and oral treatments for infantile hemangiomas, these do not work for congenital hemangiomas.

Complications

There are a number of potential complications of congenital hemangiomas, including: 

  • Skin breakdown
  • Bleeding 
  • Heart problems (though rare) because of the large amount of blood flow to the lesion

Differences between congenital hemangioma and infantile hemangioma

Congenital hemangioma

Infantile hemangioma

Present at birth and potentially diagnosable during fetal development via ultrasound. Visible between 2 weeks and 4 months of age.
Growth is complete at birth, or it may grow proportionately as your child grows. Grows rapidly for about 6 to 12 months (average is around 8 months).
Occurs equally in males and females. Occurs in five females for every male.
Less common than infantile hemangiomas, but not rare. Common (4-5 percent incidence in newborns).
Rapid or no involution (shrinking). Slow shrinking that takes months or years.