268 / 280
IH often is not apparent at birth and most appear in the
fi
rst 6 weeks of life as a soft, non-compressible mass with a
typical triphasic evolution: proliferation, plateau, and
involution. Super
fi
cial haemangiomas are generally cherry
red macules and papules; deep haemangiomas are
reasonably
fi
rm subcutaneous masses sometimes with a
bluish skin hue. Compound haemangiomas obviously
combine aspects of both types.
Most IHs double in size in the
fi
rst 2 months of life, and
approximately 80% reach their maximum size between by 6
months of age.
12
Spontaneous regression over the
fi
rst several years of life
is typical
13,14
; however, up to 40% of IHs may have residual
skin changes and
fi
bro-fatty residuum, especially in the
head and neck region. IHs within the cutaneous lumbosa-
cral region can be associated with tethered cord. In patients
with large IHs in the head and neck region there may be
concern for airway compromise, ulceration, or bleeding,
which can be medically treated, with propranolol as the
leading choice of medication (
Figs 1
and
2
a
e
b).
The immunohistochemical marker, glucose transporter
protein isoform 1 (GLUT1) has become a major tool in the
diagnosis of IH, with the endothelial cells staining strongly.
The overwhelming majority of other VTs do not stain pos-
itive for GLUT-1.
15,16
Imaging is not required for the majority of IHs but can be
useful to con
fi
rm the suspected diagnosis in atypical lesions
and to determine the extent of deep lesions and to exclude
other VTs (such as KHE), or soft-tissue malignancies. US
demonstrates a solid mass with increased colour
fl
ow
within the mass.
17
Arterial feeder and venous drainage can
be visualized using Doppler US.
18
MRI reveals a T2 bright, T1 isointense mass with homo-
geneous, avid contrast enhancement.
19
Internal serpiginous
Figure 1
SEMVAFC. IH, Infantile haemangioma; RICH, Rapidly involuting congenital haemangioma; NICH, non-involuting congenital hae-
mangioma; KHE, Kaposiform haemangioendothelioma; VM, Venous malformation; LM, Lymphatic malformation; AVM, Arteriovenous malfor-
mation; KT, Klippel
e
Trenaunay.
A. Tekes et al. / Clinical Radiology 69 (2014) 443
e
457
246