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. 2025 Jun;28(2):517-525.
doi: 10.1007/s40477-025-01005-y. Epub 2025 Mar 10.

Not everything that is red is hemangioma

Anna Masucci  1 , Dolores Ferrara  2 , Elena Sammarco  3 , Filomena Barbato  3 , Francesca De Chiara  4 , Raffaele Zeccolini  5 , Francesco Esposito  6
Affiliations

Not everything that is red is hemangioma

Anna Masucci et al. J Ultrasound. 2025 Jun.

Abstract

Purpose: To demonstrate the utility of ultrasound and color Doppler examination in differentiating red skin lesions.

Methods: We used high-frequency probes to identify common features of infantile hemangioma that can help distinguish it from other red skin lesions.

Results: In the pediatric population red skin lesions are frequently encountered in clinical practice. The most common red skin lesion is infantile hemangioma, which, in most cases, can be easily diagnosed clinically. An ultrasound examination is necessary to evaluate the lesion's depth or determine its proximity to nearby critical structures. Sometimes is not easy to differentiate it from other reddish lesions with a clinical examination alone. In recent years, thanks to the development of increasingly high-frequencies ultrasound probes, it has been possible to investigate them, evaluating their ultrasound characteristics and integrating them with those of the color Doppler examination. We highlight some ultrasound and color-Doppler features that can guide through differential diagnosis between infantile hemangioma and other clinically red skin lesions such as pyogenic granuloma, idiopathic facial aseptic granuloma, juvenile xanthogranuloma, congenital myofibroma and pilomatricoma.

Conclusions: Ultrasound and color Doppler have proven to be useful tools to guide differential diagnosis between skin lesions with a reddish color that can't be clearly identified as hemangiomas with a physical examination alone.

Keywords: Children; Doppler; Hemangioma; Soft tissue lesions; Ultrasound; Vascular anomalies.

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Conflict of interest statement

Declarations. Conflict of interest: The authors declare that there are no competing interests related to this work. Ethical approval: All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, and its later amendments. Human and animal rights: This article does not contain any studies with human or animal subjects performed by any of the authors. Informed consent: Additional informed consent was obtained from all the patients for which identifying information is not included in this article.

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