Connelly Elizabeth Alvarez, Viera Martha, Price Cynthia, Waner Milton
Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
Pediatr Dermatol. 2009 Jul-Aug;26(4):469-72. doi: 10.1111/j.1525-1470.2009.00955.x.
Infantile hemangiomas (IHs) are the most common benign vascular tumors of childhood. IH of "segmental" morphology, are clusters of hemangiomas with a configuration involving a broad anatomic territory of skin. They are the least common of all types and generally larger than regular hemangiomas, morphologically characterized as plaque-like lesions. Head and neck segmental hemangiomas have a higher risk of causing life-threatening complications and of having associated structural anomalies, i.e., PHACES syndrome (Posterior fossa malformations, hemangiomas, arterial anomalies, coartation of the aorta and other cardiac defects, eye abnormalities and sternal clefting or supra abdominal raphe). We present a patient with a segmental IH over the right anterior neck complicated by ulceration and life threatening arterial bleeding. Although segmental hemangiomas of head and neck have high incidence of ulceration, fortunately life threatening bleeding events are rare with only 7 previously recorded cases. We recommend that large, neck IH be followed closely for evidence of ulceration and that MRI/MRA be performed to adequately assess their vascular supply. Direct extension of the ulceration into arterial vessels is a possibility and can lead to severe bleeding. Life-threatening bleeding is an unusual complication of IH and may represents a surgical emergency. In such cases we recommend a multidisciplinary approach to their treatment.
婴儿血管瘤（IHs）是儿童期最常见的良性血管肿瘤。“节段性”形态的婴儿血管瘤是血管瘤的簇集，其形态涉及广泛的皮肤解剖区域。它们是所有类型中最不常见的，通常比普通血管瘤大，形态上表现为斑块样病变。头颈部节段性血管瘤引起危及生命的并发症以及伴有结构异常的风险更高，即PHACES综合征（后颅窝畸形、血管瘤、动脉异常、主动脉缩窄和其他心脏缺陷、眼部异常以及胸骨裂或上腹部中线）。我们报告一例右前颈部节段性婴儿血管瘤患者，该血管瘤并发溃疡并伴有危及生命的动脉出血。尽管头颈部节段性血管瘤的溃疡发生率很高，但幸运的是，危及生命的出血事件很少见，此前仅有7例记录在案。我们建议对颈部较大的婴儿血管瘤密切随访，观察有无溃疡迹象，并进行MRI/MRA检查以充分评估其血管供应情况。溃疡直接蔓延至动脉血管是有可能的，并且可能导致严重出血。危及生命的出血是婴儿血管瘤的一种罕见并发症，可能代表一种外科急症。在这种情况下，我们建议采用多学科方法进行治疗。
