Rare presentations of infantile hemangiomas: 4 cases

• Published in: Annales de dermatologie et de vénéréologie Vol. 145; no. 12; pp. 749 - 755
• Main Authors: Babic, V, Schoeffler, A, Moawad, S, Mainard, L, Schmutz, J-L, Bursztejn, A-C
• Format: Journal Article
• Language: French
• Published: France 01.12.2018
• Subjects: Biopsy; Buttocks; Delayed Diagnosis; Erythema - etiology; Facial Neoplasms - diagnosis; Facial Neoplasms - drug therapy; Female; Foot Diseases - diagnosis; Hemangioma, Capillary - diagnosis; Hemangioma, Capillary - diagnostic imaging; Hemangioma, Capillary - drug therapy; Humans; Infant; Infant, Newborn; Male; Neoplastic Syndromes, Hereditary - diagnosis; Neoplastic Syndromes, Hereditary - diagnostic imaging; Neoplastic Syndromes, Hereditary - drug therapy; Propranolol - therapeutic use; Remission, Spontaneous; Skin Neoplasms - diagnosis; Skin Neoplasms - diagnostic imaging; Skin Ulcer - drug therapy; Skin Ulcer - etiology; Telangiectasis - etiology; Ultrasonography; Vascular tumor; Hémangiomes infantiles; Infantile hemangioma; Échographie; Tumeurs vasculaires; Ultrasonography
• ISSN: 0151-9638
• DOI: 10.1016/j.annder.2018.07.026

Infantile hemangioma (IH) is a common benign vascular tumor in children. In most cases, diagnosis is based entirely on clinical examination. When the diagnosis is uncertain, the first-line complementary examination is Doppler ultrasound. We report 4 cases of atypical infantile hemangiomas with delayed diagnosis and non-contributory imaging. One child had congenital purple papules and nodules on the back of the foot, the second had inaugural ulceration of the buttocks, and the last two presented telangiectasia, either isolated or on an erythematous macula. In two cases, ultrasound showed no vascular lesions, and in the other two cases, the absence of hyperemia did not allow a diagnosis of IH to be made. For one patient, diagnosis was made on the basis of cutaneous biopsy, and for the other three, on the basis of clinical course. We report 4 rare forms of infantile hemangioma resulting in initial diagnostic error. The atypical nature of some IHs may direct the clinician and the radiologist toward other diagnoses that in some cases have no vascular contingent. It is important for the dermatologist to be aware of these rare forms of IH in order to reduce the time to diagnosis and allow early initiation of appropriate management.