Vascular anomalies: special considerations in children

Abstract

The diagnosis and treatment of vascular anomalies are a large part of the caseload for paediatric interventional radiologists. Although many of the principles of sclerotherapy and embolisation are the same in adult and paediatric practice, there are some key differences in the approach for children, including some longer term thinking about managing these chronic diseases and their impact on a growing child. Vascular tumours are not often seen in adult IR practice and the rarest can be life threatening; knowledge of the commonest types and the role IR can play in their management can be instrumental in ensuring that children get appropriate treatment in a timely manner. Vascular anomalies also encompass some conditions associated with complex overgrowth, a subject that often causes confusion and uncertainty for interventional radiologists. This paper presents a simplified and practical approach to this spectrum of disease.

Keywords: Embolisation; Fibroadipose vascular anomaly; Haemangioma; Lymphatic malformation; Paediatric; Sclerotherapy; Vascular malformation; Venous malformation.

Fig. 1

Typical appearance of a superficial infantile haemangioma

Fig. 2

Classic appearance of a non-involuting congenital haemangioma (NICH). They have a more purple colour than the commoner infantile haemangiomas

Fig. 3

Coronal T2 weighted MR image, showing a large rapidly-involuting congenital haemangioma (RICH) occupying almost all of the liver in a 3-day old male. The lesion caused splinting of the diaphragm, high output cardiac failure and abdominal compartment syndrome

Fig. 4

a a kaposiform haemangioendothelioma (KHE) in a 1 month old female. Clinically, the lesion appears more aggressive in nature than the common infantile haemangiomas; b an ultrasound image of a KHE in another patient, showing a far more heterogenous parenchymal echotexture than that seen in haemangiomas

Fig. 5

Venous malformation (VM) of the knee in a 10 year old female. a Axial T2 weighted MR image shows VM within the soft tissues around the knee and within the knee joint itself; b AP radiograph confirms severe articular damage to the knee joint. Soft tissue thickening and phleboliths are also noted

Fig. 6

Venous malformations (VMs) that may be better suited to bleomycin sclerotherapy than with other agents a VM with a superficial component involving the dermis, which is likely to blister with other agents; b axial T2 weighted MR image of a VM of the left posterior orbit and eyelid in a 3 year old female. Intracranial abnormalities are also noted; c axial T2 weighted MR image of the wrist in a 14 year old female. The VM lies within the carpal tunnel itself

Fig. 7

Multiple cutaneous lesions with the classic features of blue rubber bleb naevi in a 2 year old male

Fig. 8

Characteristic appearance of infected or inflamed lymphatic vesicles in a teenage child with a lymphatic malformation of the buccal mucosa

Fig. 9

Axial T2 weighted MR image of a 9 year old male with a lymphatic malformation of the right buttock. The subcutaneous lymphatic cysts, which are of high T2 signal, are of varying sizes and there is additional fat present, contributing to the bulk of the lesion

Fig. 10

Coronal T2 weighted MR image of a large mesenteric lymphatic malformation in a 2 year old male. This lesion would be suitable for serial sclerotherapy via 2–3 pigtail drains

Fig. 11

Lymphatic malformation in a 2 day old male. a coronal and b axial T2 weighted MR images delineate the complex lesion causing marked distortion of the anatomy of the neck. On the axial image, the prevertebral disease (thin arrow) displaces the trachea (thick arrow); this is the area that should be targeted with sclerotherapy to improve the child’s respiratory status. The more bulky, superficial disease (broken arrow), although tempting to treat, is of little clinical consequence at this stage

Fig. 12

a sagittal T1 weighted MR image of the forearm in a 12 year old female. The FAVA lesion (short arrow) replaces almost all of the flexor compartment and is causing contracture at the wrist; b US image of a FAVA lesion of the calf, showing marked echogenicity of the affected muscle (thick arrow) and central dysplastic veins (thin arrow)