Congenital Hemangiomas

A congenital hemangioma (CH) is a benign (non-cancerous) vascular tumor that usually looks like a soft, raised, purple-red nodule, often with dilated blood vessels over top. CHs grow in utero and are fully developed and visible at birth. CHs most commonly appear on the head, neck, arms and legs, but can also be present inside the body, including on the liver.

There are three types of congenital hemangiomas:

• Rapidly involuting congenital hemangiomas (RICH) begin to shrink rapidly after birth and throughout the first year of life. This type of hemangioma disappears completely by the time the child is around 18 months old. It may leave behind changes to the skin where it was located.   
• Partially involuting congenital hemangiomas (PICH) begin to shrink after birth but do not disappear entirely.
• Non-involuting congenital hemangiomas (NICH) do not get smaller over time.

Congenital hemangiomas can be raised or flat and are often purple-red in color. The tumor itself does not grow, but may become proportionally larger as the child grows. Occasionally, a PICH or NICH can have some re-growth around the time a child begins puberty. Very rarely, if large enough that they have significant blood flow in them, a congenital hemangioma can create a risk of heart failure.

Congenital hemangiomas are fairly rare. They are caused by a mutation in the genes GNAQ or GNA11, which leads to overgrowth of the vascular tissue.

Congenital hemangiomas may be visible on an ultrasound before the baby is born. Most often, however, the condition is diagnosed after the baby is born. A patient is seen at Children's Hospital of Philadelphia’s (CHOP) Comprehensive Vascular Anomalies Program (CVAP), which includes the multiple specialists involved in the care of children with congenital hemangiomas. Imaging, such as an ultrasound or MRI, leads to an initial assessment. A biopsy is sometimes needed in order to confirm the diagnosis.

In the majority of cases, congenital hemangiomas do not cause complications and will not need to be treated. The CVAP team will monitor the hemangioma and consider treatment options if it affects other organs or systems, such as breathing or vision or heart function, as well as for evidence of bleeding or skin breakdown. Congenital hemangiomas that cause complications will be surgically removed.

The CHOP difference

Children seen by the CVAP team at CHOP benefit from a multidisciplinary team with extensive experience and deep expertise in the assessment and management of congenital hemangiomas. World-class specialists offer comprehensive care tailored to each child’s condition. The CVAP team at CHOP supports patients and their families every step of the way in their journey in managing a diagnosis of congenital hemangioma.