Hemangiomas

Project 9 of 12

Hemangiomas are benign tumors that originate from the endothelial cells that line blood vessels. They may be capillary or cavernous. In capillary hemangiomas, the tumor is composed of small blood-filled spaces, has a pink-red color and look like a strawberry. Capillary hemangiomas grow rapidly during the first 1-2 years of life, and later, they become smaller and finally disappear in 90-95% of the cases. They are most commonly located on the skin, and mostly in the head and neck region. Capillary hemangiomas do not require any treatment in most cases.

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Cavernous hemangiomas are also known as “venous malformations”. These hemangiomas are blue-purple in color and have larger blood-filled spaces. They have a very slow venous flow. Cavernous hemangiomas may occur anywhere in the body, but they are most commonly located in the liver, vertebras and extremities. Unlike capillary hemangiomas, cavernous hemangiomas do not disappear spontaneously. They may even continue to grow and cause symptoms by time. If they are located under the skin they may cause pain and aesthetic problems. Liver hemangiomas may also cause pain, fullness, and rarely, bleeding. Vertebral hemangiomas are generally asymptomatic, but they can create pain and sometimes cause compression fractures. Cavernous hemangiomas do not require treatment unless they grow or cause problems. If they create symptoms and potential risks such as bleeding and fracture, treatment is indicated.

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How are they diagnosed?

Cavernous hemangiomas are generally diagnosed and differentiated from other tumors quite easily based on their typical imaging findings on ultrasound, CT and MRI. Rarely, it may be necessary to make a percutaneous biopsy for definitive diagnosis.

Nonsurgical treatments:

Some cavernous hemangiomas can be removed surgically. In most cases however, surgery is either not suitable or not desired by the patient. In such cases, the most frequently employed treatment is percutaneous sclerotherapy. For this, a tiny needle is inserted through the skin and placed into the hemangioma under ultrasound or CT guidance, and sclerosing agents are injected. These agents first cause swelling, pain and tenderness, but then, the tumor becomes smaller. After repeated sclerotherapy sessions, the hemangioma shrinks significantly, symptoms such as pain disappears and risks such as bleeding and fracture are reduced. Percutaneous sclerotherapy is mostly performed in hemangiomas located under the skin, in the muscle or liver.

If sclerotherapy is not successful, thermal ablation methods such as laser and radiofrequency can be utilized. These methods are generally used in liver hemangiomas, but they can also be used in extremity hemangiomas with a careful technique. In liver hemangiomas, also the feeding arteries of the tumor can be occluded with small particles via a femoral angiography. This technique is called embolization, and can help the shrinkage of hemangioma. In vertebral hemangiomas, percutaneous sclerotherapy and embolization can be performed. In some cases, it may be necessary to place a needle into the vertebra and inject a special “cement”. This method is called vertebroplasty and can be used in vertebral hemangiomas to obviate pain and prevent compression fractures.

Interventional Treatments