Hemangioma, Vascular, and Lymphatic Malformations

Vascular malformations often visible at birth

Hemangioma, Vascular and Lymphatic Malformations (HVLM) are lymphatic vessels or blood vessels that develop abnormally. They are often visible at birth. For example, parents and healthcare providers may notice a discolored skin lesion (birth mark) or an unusual swelling.

Two main forms of HVLM

Vascular tumors

A growth formed from abnormal blood vessels. These are mostly benign tumors but can sometimes be malignant.

Common vascular tumors are infantile hemangioma (also called hemangioma of infancy)

This is a tumor made up of small closely packed abnormal blood vessels and is often described as a strawberry hemangioma due to its appearance. It is the most common soft tissue tumor in children, usually appearing at 4-6 weeks of age and rapidly growing in the first year of a child’s life

Less common vascular tumors

Kaposiform hemangioendothelioma. This is a fast-growing tumor, that can cause a low platelet count due to platelets being trapped within the tumor
Tufted Hemangioma. A benign tumor with “tufts” of capillaries within the skin. This occurs during infancy or early childhood
Epithelioid hemangioendothelioma. This is a rare tumor that affects the lining of blood vessels, and commonly occurs in the soft tissue, liver, lungs and bones

Vascular malformations

Malformation of capillaries (small blood vessels). It is also commonly known as port wine stain, stork’s patch, Angel’s kiss, or salmon patch/nevus flammeus

Malformation of veins (vessels that carry oxygen poor or “blue blood” from the tissue/organs to the heart). This is called venous malformation

Malformation of arteries (vessels that take oxygen rich blood away from the heart to the body tissues). This is known as arteriovenous malformation or fistula (AVM, AV fistula)

Malformation of lymphatics (vessels that circulate lymph fluid that help rid the body of toxins). This is referred to as a lymphatic malformation, but is also known as lymphangioma or cystic hygroma

Malformation of a combination of different types of blood vessels is also possible

Disorders such as V Klippel Trenaunay, Parks-Weber, PROTEUS, CLOVES, and Sturge-Weber can also include vascular and lymphatic malformations

Treatments

Treatment and support for HVLM includes:

Propranolol and/or corticosteroids are used to treat infantile hemangiomas

Sirolimus (Rapamune) can be used to treat complex venous and lymphatic malformations

Anticoagulants (blood thinning medications) are used to prevent or treat clotting in at-risk vascular lesions

Physical therapy consultations are available for custom-made pressure garments for venous and lymphatic anomalies, information on local resources, and recommendations for lesions involving limbs and impaired mobility

Care coordination with other specialists for:

Sclerosing injections (the injection of a drug into a malformation to make it shrink) is used for the treatment of venous and lymphatic malformations. This technique is performed by an interventional radiologist
Pulsed dye laser (use of a laser to destroy abnormal vessels) and intralesional steroids (a medicine to decrease swelling). This technique is performed by a dermatologist
Surgical removal of lesions by a pediatric or adult plastic surgeon
Laser treatment for airway and oral hemangiomas performed by ear/nose/throat surgeons
Debulking surgery (removing tissues) for various lesions of limb overgrowth syndromes. This is performed by orthopedic specialists

Some vascular lesions may become infected, cause heart failure, be located in the brain, or are associated with genetic syndromes; in these cases, infectious disease, cardiology, neurology, and genetic specialists are available to treat you or your child. At the IHTC, we can help you coordinate this care.

How the IHTC can help you

The IHTC Hemangioma, Vascular and Lymphatic Malformations (HVLM) clinic is committed to providing expert care for infants, children, teens and adults with hemangiomas and congenital vascular/lymphatic anomalies. As a center of excellence in the treatment of bleeding and clotting disorders, the IHTC offers a high level of coordinated care for patients with vascular anomalies.

Our care includes medical therapies as well as coordination between required specialties: ENT, plastic surgery, dermatology, ophthalmology, radiology, and surgery. We also provide prompt communication with your local healthcare provider related to our treatment plan and your progress. The IHTC team collaborates with national experts and patient participation in research studies may be available.