Some infants have multiple (also referred to as multifocal) hemangiomas. The number of hemangiomas can be quite variable, ranging from a few to hundreds. In patients with numerous hemangiomas, the hemangiomas tend to be smaller in size. It is most common for hemangiomas to appear on the skin, but they can develop in internal organs as well. The risk of having internal involvement increases with the total number of skin hemangiomas. It is very rare in infants with 4 or fewer hemangiomas, but becomes higher if there are more. The liver is the most common internal site affected; hemangiomas in sites other than the liver are far less common. If liver hemangiomas are present, thyroid hormone levels should be checked, because infants with liver hemangiomas can also have low thyroid hormone levels. If 5 or more skin hemangiomas are present, a liver ultrasound is recommended. Other evaluations for internal involvement include a careful history and physical examination. It may include other imaging studies or bloodwork depending on the individual situation. Like hemangiomas on the skin, internal hemangiomas also grow during infancy and regress (go away) during childhood.
Most internal hemangiomas do not require treatment, but if symptoms are present, the lesions are excessively large, or rapid growth is seen, treatment may be needed to slow growth and prevent complications.
This infant girl presented with numerous skin hemangiomas, and an enlarged liver with liver hemangiomas noted on ultrasound. She was treated with oral propranolol with marked improvement of the skin hemangiomas, and resolution of the liver hemangiomas.
Related HIG Research:
Horii KA, Drolet BA, Frieden IJ, Baselga E, Chamlin SL, Haggstrom AN, Holland KE, Mancini AJ, McCuaig CC, Metry DW, Morel KD, Newell BD, Nopper AJ, Powell J, Garzon MC; Hemangioma Investigator Group. Prospective study of the frequency of hepatic hemangiomas in infants with multiple cutaneous infantile hemangiomas. Pediatr Dermatol. 2011 May-Jun;28(3):245-53. Pubmed