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Thread: Capillary Hemangioma picture - Pediatric Atlas

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    Default Capillary Hemangioma picture - Pediatric Atlas

    Why do capillary hemangiomas on the eyelids cause vision problems?
    Capillary Hemangiomas of the eyelid can cause amblyopia (decreased vision) by two mechanisms. First, if the lesion exerts pressure on the surface of the eye, this causes astigmatism and the baby may develop refractive amblyopia. Second, if the lesion causes the eyelid to droop significantly (ptosis) to the extent that it blocks vision in the eye, this can result in occlusion amblyopia.

    If amblyopia develops in the affected eye, it can be treated with glasses and/or occlusion therapy using patches or atropine drops.

    How does a capillary hemangioma in the eye socket cause vision problems?
    A capillary hemangioma in the eye socket (the area around the eye called the orbit) can put pressure on the eye and result in amblyopia or strabismus. It can also press on the optic nerve which may cause optic nerve atrophy. Any of these conditions may damage vision.

    Do all capillary hemangiomas around the eye need to be treated?
    No. The majority of capillary hemangiomas around the eye do not require treatment. They are simply monitored for the development of vision problems. Treatment is needed only if there is a threat to vision.

    How are capillary hemangiomas treated?
    Capillary hemangiomas can be treated in a variety of ways depending on the location of the hemangioma, its severity, and whether or not it is causing vision problems.

    Propranolol is an effective medication that is used in the treatment of hemangiomas. Usually it is taken orally but in some cases it can be applied topically if the hemangioma is very small and thin. Since propranolol can affect heart rate and blood pressure, careful monitoring at the beginning of treatment is sometimes required and may include a brief admission to the hospital.

    Steroid medications can also be used to treat hemangiomas. Steroids can stop the progression of hemangiomas by causing the blood vessels to shrink. Depending on the size and location of the hemangioma, steroids may be prescribed by mouth, injected directly into the hemangioma, or applied to the surface of the hemangioma. Steroid medications can have undesirable side effects including delayed physical growth, cataract, glaucoma and central retinal artery occlusion.

    Laser treatments can sometimes be used on superficial hemangiomas to prevent growth, diminish their size, or lighten their color.
    Capillary Hemangioma picture Pediatric Atlas attachment.php?s=a743a6c6dc9942fc681a972ab12b911c&attachmentid=333&d=1435866284

    Traditional surgery to remove hemangiomas around the eye is generally reserved for small, well-defined hemangiomas that are located under the skin surface.

    How long does it take for the capillary hemangioma to go away?
    Capillary hemangiomas typically take several years to regress. The involved skin may retain a red color or may be slightly puckered in appearance, or may look perfectly normal depending upon how completely the hemangioma resolves

    Pathophysiology
    Capillary hemangiomas are believed to be hamartomatous proliferations of vascular endothelial cells. They are now thought to be of placental origin due to a unique microvascular phenotype shared by juvenile hemangiomas and human placenta. Periorbital capillary hemangiomas follow a similar course to hemangiomas on other parts of the body. They generally exhibit 2 phases of growth, a proliferative phase and an involutional phase. The proliferative phase of rapid growth typically occurs from 8-18 months. Pathologically, it is characterized by an increased number of endothelial and mast cells, the latter being a stimulus for vessel growth. Endothelial cell proliferation returns to normal following the proliferation phase.

    The involutional phase is characterized by slow regression of the hemangiomas. One half of all lesions will involute by age 5 years, and 75% will involute by age 7 years. During this phase, mast cell numbers decrease to normal and there is a decrease in endothelial and mast cell activity. These vascular spaces become lined with endothelial cells without muscular support.

    Imaging Studies
    Neuroimaging studies can be of great assistance in establishing the diagnosis.
    Ultrasonography shows a lesion with irregular contour and low-to-medium internal reflectivity.
    CT scan reveals a poorly circumscribed mass with no bony erosion. The lesion usually enhances with intravenous contrast.
    Magnetic resonance imaging (MRI) reveals a lesion that is hypointense to fat on T1-weighted scans and hyperintense to fat on T2-weighted scans.
    A well-circumscribed lobular pattern with prolonged parenchymal staining is seen with angiography. Involuting lesions tend to have less tissue staining.
    Cardiac echocardiography and imaging of the great vessels are useful in the diagnosis of PHACES syndrome.

    Histologic Findings
    Pathological findings include proliferation of a single layer of endothelial cells and pericytes. Endothelial cells of the basement membrane characteristically have large amounts of endoplasmic reticulum. The small vascular spaces lead to the formation of a high-flow lesion.

    Medical Care
    The indications for treatment can be divided into systemic, ophthalmic, and dermatologic reasons. Systemic reasons for intervention include congestive heart failure, thrombocytopenia, hemolytic anemia, and nasopharyngeal obstruction. Ophthalmic indications for intervention include occlusion of the visual axis, optic nerve compression, severe proptosis, and anisometropia.Dermatologic indications for intervention include maceration and erosion of the epidermis, infection, and cosmetic disfigurement.
    Capillary Hemangioma picture Pediatric Atlas attachment.php?s=a743a6c6dc9942fc681a972ab12b911c&attachmentid=334&d=1435866310

    Surgical Care
    See the list below:
    Laser surgery has been attempted to ameliorate capillary hemangiomas but is still controversial. The hemostatic effects of the carbon dioxide laser have been used with success to surgically remove these lesions. Other lasers used include the argon laser and the Nd:YAG laser. The pulsed dye laser is only effective for very superficial lesions; its mechanism of action is too slow for sight-threatening hemangiomas. Overall, variable results have been seen with various laser modalities, and the risks of scarring and ulceration often deter its use.
    Incisional surgical techniques also have had variable success. Surgical ligation of the hemangiomas produces equivocal results. Vascular embolization of the lesions should be used for large extraorbital hemangiomas only. Primary excision also has been advocated for infantile hemangiomas. Early surgical intervention can be considered as a primary treatment option in selected, isolated capillary hemangiomas without a significant cutaneous component. Surgery can provide definitive early treatment and prevent astigmatism and occlusion-related amblyopia.

    References:
    http://emedicine.medscape.com/articl...5-treatment#d8
    Capillary Hemangioma AAPOS











    Last edited by Medical Photos; 09-01-2015 at 07:49 PM.

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