Pediatric Clinics of North America - CIPERJ

342 ADAMS & WENTZEL
birth but do not involute. Both lesions are high flow lesions that can be
misdiagnosed as arteriovenous malformations [AVMs]. Congenital hemangiomas
can cause congestive heart failure that has been reported in utero.
There are distinguishing histochemical endothelial markers (such as
GLUT-1), which are present in hemangiomas of infancy but not in the
other vascular tumors [7]. Hemangiomas are a mixture of cell types, including
endothelial cells (CD31þ), pericytes (SMAþ), dendritic cells (factor
XIIIaþ), and mast cells. Continuing research in this area should provide
insights into the pathology, pathophysiology, and molecular basis of these
benign vascular tumors.
Infantile hemangiomas can be associated with other anomalies or conditions
that may require further evaluation or immediate medical management.
Hemangiomas in the cervicofacial region that cover the chin, neck,
or face in a ‘‘bearded’’ distribution are associated with airway hemangiomas
[8]. Any bearded hemangioma should be evaluated by an otolaryngologist
whether or not respiratory symptoms are present (Fig. 2). Infants who
have hemangiomas in this area should be monitored closely, and medical
management should be initiated if airway involvement is suspected.
Hemangiomas in the lumbosacral area can signal underlying occult spinal
dysraphism (lipomeningocele, tethered spinal cord, and diastematomyelia).
These hemangiomas also can be associated with genital urinary defects
[9,10]. Ultrasound (!6 months of age) or MRI (O6 months of age) evaluation
of the spine and ultrasound of the genitourinary region is recommended
for these patients. Infants who have multiple (O5) cutaneous hemangiomas
can have focal visceral tumors involving the liver, spleen, lung, brain, and
intestines. Liver hemangiomas (Fig. 3) are the most common of the visceral
Fig. 2. Bearded hemangioma: high risk for airway lesions; otolaryngolic evaluation is
recommended.