Hemangioma and Vascular Malformations
Expert diagnosis and treatment for hemangiomas and vascular malformations are available at Riley Hospital for Children Radiology at Indiana University Health. In the past, parents had to take their children out of state for treatment of these disorders. Since 2004, Riley Hospital for Children Radiology at IU Health has offered complete diagnosis and treatment for vascular malformations.
What are Hemangiomas and Vascular Malformations?
In a developing fetus, the circulatory system (arteries and veins) and lymphatic system (a second system that fights infection) can develop abnormal clusters of veins or arteries. These tumors or clusters are called vascular (circulatory) malformations. Sometimes one of these malformations develops into a tumor, which is then called a hemangioma. Although these malformations develop before birth, symptoms may not develop until a child is older.
What Are the Types of Vascular Malformations?
Vascular malformations and hemangiomas typically grow at a constant rate. Serious injury, some medications and hormonal changes (such as puberty) can sometimes cause these malformations to grow rapidly. There are four major types of vascular malformations:
Arteriovenous malformations are abnormal direct connections between arteries, carrying blood from the heart and veins and returning blood to the heart. Normally, arteries deliver blood to smaller and smaller blood vessels until the blood flows through tiny vessels (capillaries). These capillaries allow oxygen to transfer into cells of the body’s tissues and cellular waste products to flow into blood cells. Veins then carry this blood back to the heart. Waste products are removed from the blood by various organs, such as the liver and kidneys. Blood flow through these malformations interferes with the blood’s delivery of oxygen and removal of waste products. As the malformation grows, it reduces the amount of blood available to serve the body’s tissues. To compensate, the heart must work harder and can enlarge, leading to heart failure. Other dangers of arteriovenous malformations include skin breakdown, damage to the lungs, liver or brain.
Hemangiomas are benign (noncancerous) tumors that develop as a result of an abnormal cluster of blood vessels. These tumors usually form in the skin or in organs such as the liver. Hemangiomas on the skin appear as red marks that may be raised above the skin. They may not need treatment. Most skin hemangiomas disappear by the time the child is 10 years old. Hemangiomas on the liver rarely cause symptoms and may not be noticed until they grow large enough to be felt as a mass in the abdomen.
The lymphatic system is a network of vessels similar to blood vessels that connect small enlargements called lymph nodes. A clear fluid called lymph flows through the system carrying dangerous germs and substances that have been passed to the lymphatic system from the body’s tissues. As lymph flows through the lymph nodes, various cells and proteins there destroy these germs and substances. Malformations of the lymphatic system develop as sponge-like growths that slow circulation of lymph. Eventually these growths become large masses.
Venous malformations are clusters of abnormally large veins. These clusters grow steadily larger as a child grows and are the most common type of vascular malformation. These malformations can be dangerous and require treatment because they can cause clots to form in the bloodstream or may cause disorders that reduce the blood’s ability to clot.
What Causes Hemangiomas and Vascular Malformations?
Many of hemangiomas and vascular malformations happen by chance. It is also possible that an abnormal gene causing the problem can be inherited. Parents who have the abnormal gene may not know this because their hemangioma or vascular malformation has not caused symptoms and has not been diagnosed. They find out about the disorder only when a child is diagnosed with a hemangioma or vascular malformation. If a parent has the disorder, each child has a 50/50 chance of inheriting it.
What Are the Symptoms of Hemangiomas and Vascular Malformations?
These malformations can appear in forms similar to venous malformation. However, symptoms of advanced arteriovenous malformations can also include shortness of breath and fatigue. Arteriovenous malformations cause blood to bypass the lungs, so less oxygen is available for body tissues. Eventually, the heart becomes enlarged as it works to maintain the oxygen level in the blood. This can cause heart failure. Clots can also pass through arteriovenous malformations and then through the heart to various organs. If these clots block blood vessels, the organs can be damaged.
Hemangiomas on the skin appear as red marks and occur mostly on the neck and face. When hemangiomas on internal organs grow large enough, they can cause a variety of symptoms, including:
- Abdominal discomfort
- Loss of appetite
- Nausea and vomiting
- Weight loss
Lymphatic malformations often result in lymph leaking through the skin and can cause a visible lump. Germs can also enter the body where these malformations are close to the skin, resulting in frequent and serious infections. When lymphatic malformations are involved with other parts of the body, they can cause a variety of symptoms:
- Bone. A lymphatic malformation in bone can cause pain and destruction of bone tissue.
- Gastrointestinal tract. Lymphatic malformations on the stomach or intestines can result in malabsorption (reduced ability of the body to gain nutrients from food).
- Trachea (windpipe) or chest. Malformations in this area can interfere with breathing.
Venous malformations appear as red marks on the skin or as deeper masses that cause bumps in the skin. Some malformations can be so close to the surface that they break and bleed. In any location, venous malformations may be painful.
How Are Hemangiomas and Vascular Malformations Treated?
There are four major treatment options for these malformations:
- Observation. Not all hemangiomas or vascular malformations need immediate treatment. If the malformation is not causing symptoms or damage, your doctor may recommend that your child come in regularly to be examined. As the malformation develops, your child may eventually need treatment.
- Medication. Two medications we use often to treat hemangiomas are steroids and propranolol. In some cases we may also use some chemotherapy drugs to treat dangerous hemangiomas we cannot treat in other ways.
- Surgery. If the malformation or hemangioma is clearly defined, we can remove it surgically.
- Scarring. Often a vascular malformation or hemangioma can be scarred in such a way that it no longer functions or grows, and blood or lymph can flow normally through vessels around it. We can scar the malformation in three ways:
- Embolization. A medication is delivered to the hemangioma or malformation by passing a special tool through a vein or artery into the malformation.
- Laser. We use laser light to burn the hemangioma or malformation, scarring it and causing blood or lymph to pass through healthy vessels nearby.
- Sclerotherapy. This is injections of a medication directly into a vascular malformation to cause it to turn into scar tissue that cannot function. Blood or lymph then pass through other, normal vessels nearby.
Possible complications of these scarring procedures include pain, swelling, infection and blistering of the skin.
How Can I Get Treatment for My Child?
Riley Radiology at IU Health has an interdisciplinary team with extensive experience diagnosing and treating hemangiomas and vascular malformations. Our interventional radiologist (who uses ultrasound to guide treatment for these disorders) works with other specialists to provide the complete range of treatment for your child. These specialists include:
- Dermatologist (skin specialist)
- Hematologist (blood specialist)
- Orthopedist (to treat malformations in joints)
- Otolaryngologist (ENT—a specialist in disorders of the head and neck)
- Plastic surgeon
Our interventional radiologist is Francis Marshalleck, MD, the director of pediatric interventional radiology at Riley Hospital for Children at Indiana University Health. He has extensive experience diagnosing and treating hemangiomas and vascular malformations. His residency was at the University of Texas at Houston. His fellowship was at Indiana University School of Medicine and at the Hospital for Sick Children in Toronto, Canada. Dr. Marshalleck’s clinical interests include pediatric interventional radiology and interventional oncology.
You can call our office to make an appointment with Dr. Marshalleck.
Indiana Radiology Partners
Riley Hospital for Children at Indiana University Health
705 Riley Hospital Drive, Room 1053
Indianapolis, IN 46202
Physicians please call 317.948.6328 to speak to our office and refer a patient to our interventional radiologist.