Kristy L Rialon1,2, Rudy Murillo1,2, Rebecca D Fevurly1,2, Ann M Kulungowski1,2, David Zurakowski1, Marilyn Liang2,3, Harry P W Kozakewich2,4, Ahmad I Alomari2,5, Steven J Fishman1,2. 1. Department of Surgery, Boston Children's Hospital, Boston, Massachusetts. 2. Vascular Anomalies Center, Boston Children's Hospital, Boston, Massachusetts. 3. Department of Dermatology Program, Boston Children's Hospital, Boston, Massachusetts. 4. Department of Pathology, Boston Children's Hospital, Boston, Massachusetts. 5. Department of Radiology, Boston Children's Hospital, Boston, Massachusetts.
Abstract
OBJECTIVES: Hepatic hemangiomas are often found in association with multiple cutaneous infantile hemangiomas. Screening abdominal ultrasonography has been recommended for patients with five or more cutaneous lesions. We sought to determine whether hemangiomas found through screening had improved clinical outcomes. METHODS: Patients entered into our hepatic hemangioma registry between 1995 and 2012 were reviewed. RESULTS: Seventy-two patients with multiple cutaneous and hepatic hemangiomas were identified; 43 (60%) were detected through screening. The median age at diagnosis was 41 days for screened patients and 53 days for those not screened. Screening detected 40 (93%) multifocal and 3 (7%) diffuse hemangiomas, compared to 18 (62%) and 11 (38%), respectively, in the nonscreened group. Patients identified by screening had lower incidences of congestive heart failure and hypothyroidism and were less likely to receive treatment for their hemangiomas. The mortality rate in the children not screened was 28% (n = 8). None of the patients found by screening died (p < 0.001). Multivariate analysis of treated patients demonstrated that screening was a significant predictor of reduced mortality (p = 0.04). CONCLUSION: Hepatic hemangiomas found through screening ultrasonography are less likely to develop serious clinical sequelae. Although the reasons for this may include detection of hemangiomas that are less likely to progress to symptomatic disease, it appears that it also allows for earlier intervention for more concerning (e.g. diffuse) subtypes. Screening may allow for closer surveillance and earlier treatment before life-threatening progression in a subset of infants with liver hemangiomas, preventing complications and reducing mortality.
OBJECTIVES:Hepatic hemangiomas are often found in association with multiple cutaneous infantile hemangiomas. Screening abdominal ultrasonography has been recommended for patients with five or more cutaneous lesions. We sought to determine whether hemangiomas found through screening had improved clinical outcomes. METHODS:Patients entered into our hepatic hemangioma registry between 1995 and 2012 were reviewed. RESULTS: Seventy-two patients with multiple cutaneous and hepatic hemangiomas were identified; 43 (60%) were detected through screening. The median age at diagnosis was 41 days for screened patients and 53 days for those not screened. Screening detected 40 (93%) multifocal and 3 (7%) diffuse hemangiomas, compared to 18 (62%) and 11 (38%), respectively, in the nonscreened group. Patients identified by screening had lower incidences of congestive heart failure and hypothyroidism and were less likely to receive treatment for their hemangiomas. The mortality rate in the children not screened was 28% (n = 8). None of the patients found by screening died (p < 0.001). Multivariate analysis of treated patients demonstrated that screening was a significant predictor of reduced mortality (p = 0.04). CONCLUSION:Hepatic hemangiomas found through screening ultrasonography are less likely to develop serious clinical sequelae. Although the reasons for this may include detection of hemangiomas that are less likely to progress to symptomatic disease, it appears that it also allows for earlier intervention for more concerning (e.g. diffuse) subtypes. Screening may allow for closer surveillance and earlier treatment before life-threatening progression in a subset of infants with liver hemangiomas, preventing complications and reducing mortality.
Authors: Robert E Shaddy; Aneesh Thomas George; Thomas Jaecklin; Eimear Nic Lochlainn; Lalit Thakur; Rumjhum Agrawal; Susan Solar-Yohay; Fabian Chen; Joseph W Rossano; Thomas Severin; Michael Burch Journal: Pediatr Cardiol Date: 2017-12-20 Impact factor: 1.655
Authors: C Mahon; K McHugh; N Alband; D Rampling; N Sebire; E Williamson; M Glover; V A Kinsler Journal: Br J Dermatol Date: 2020-12-28 Impact factor: 11.113