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Musculoskeletal » Superficial
Abdominal wall hemangioma
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Presentation A month old neonate presented with anterior abdominal mass and was referred for an ultrasound.
Caption: Sagittal scan of the anterior abdominal wall.
Description: A mildly lobulated, solid mass showing mixed echogenicity is identified in the superficial abdominal wall layers. No defect was noted in the anterior abdominal wall musculature.
Caption: Color Doppler view of the mass.
Description: There is significant flow noted within the mass.
Caption: Sagittal color Doppler view
Description: A vessel feeding the mass is noted to arise from within the intra-abdominal area, likely the epigastric artery.
Caption: Spectral waveform of the vessel feeding the mass.
Description: An arterial waveform was identified on spectral waveform analysis.
Differential Diagnosis Abdominal wall hemangioma, neoplasm in the superficial tissues of the anterior abdominal wall.
Final Diagnosis Abdominal wall hemangioma.
Discussion Subcutaneous hemangiomas are common benign soft tissue neoplasms that consist of increased blood vessels. These may proliferate rapidly in infancy and may involute later. Some actually consider them to be hamartomas and these may be superficial [capillary or cavernous] or intramuscular [deep] in location or may occur within organs. Hemangiomas can be solitary and sporadic, can be diffuse [known as angiomatosis] or can be a component of various neurocutaneous syndromes such as Von Hippel Lindau and Klippel Trenaunay syndrome.

Ultrasound can be used to distinguish between soft tissue hemangiomas from other vascular malformations and also other masses. In cases of superficial hemangiomas, ultrasound demonstrates a hypoechoic, hyperechoic or mixed echogenicity solid mass usually located within the subcutaneous fat. The presence of flow within the mass distinguishes it from a non-vascular mass. Once the diagnosis of a vascular mass is made, the differentiation of a hemangioma from other vascular masses can be made if specific criteria are fulfilled. The superficial hemangiomas showed a high number of internal vessels with the feeder vessel usually being identified. These vessels, if arterial, showed a low resistance flow and, if venous, showed a normal venous spectral waveform. A study by Dubois, et al concluded that high vessel density within the mass [> 5 vessels per square cm] and high peak arterial Doppler shift could be used as diagnostic criteria to diagnose hemangiomas.

Most superficial hemangiomas in the infant involute spontaneously, in which case ultrasound offers non-invasive monitoring of these patients; however treatment with flash lamp-pumped dye laser can be offered. In cases of large hemangiomas which may present with consumptive coagualopathy [Kasabach Meritt syndrome], operative measures might have to be considered.

Case References 1, Li B, et al. Diagnosis and treatment of subcutaneous cavernous hemangioma with color Doppler ultrasonography. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2002 May; 16(3):193-4.
2. Bakhach S, et al. Color Doppler sonography of superficial capillary hemangiomas. J Radiol. 2001 Nov; 82(11):1613-9. 3. Paltiel HJ, et al. Soft-tissue vascular anomalies: utility of US for diagnosis. Radiology. 2000 Mar; 214(3):747-54.
4. Dubois J, et al. Soft-tissue hemangiomas in infants and children: diagnosis using Doppler sonography. AJR. 1998 Jul; 171(1):247-52.
5. Rozylo-Kalinowska I, et al. Application of Doppler ultrasonography in congenital vascular lesions of the head and neck. Dentomaxillofac Radiol. 2002 Jan; 31(1):2-6.
Follow Up The neonate was operated upon and the mass removed. Histopathology proved it to be a hemangioma.
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