Department of Dermatology, Nantes University Hospital, Nantes, France.
Department of Intensive Care of Neonatology, Nantes University Hospital, Nantes, France.
JAMA Dermatol. 2015 Apr;151(4):422-5. doi: 10.1001/jamadermatol.2014.3666.
Congenital hemangiomas (CHs) are rare benign vascular tumors that differ from common infantile hemangiomas in that they grow in utero and are fully developed at birth. While ulceration is a common, predominantly benign complication in infantile hemangioma, little is known about the prognosis of ulcerated CH. However, it has been observed that ulcerated CH may be complicated by life-threatening bleeding episodes.
We report 2 cases of ulcerated rapidly involuting congenital hemangiomas (RICH) that were complicated by life-threatening bleeding episodes in the neonatal period. In both cases, the CHs were fed by high-flow vessels and the ensuing massive bleeding was due to superficial vessel wall erosion induced by the ulceration. Both patients were successfully treated with intravascular embolization; one patient underwent additional hemostatic surgery.
These 2 cases highlight the importance of closely monitoring children with ulcerated CH because of the risk of severe bleeding. Embolization is the treatment of choice in the case of severe bleeding, as the natural history of RICH is to spontaneously regress.
先天性血管瘤（CH）是罕见的良性血管肿瘤，与常见的婴儿血管瘤不同，它们在子宫内生长，出生时已完全发育。虽然溃疡是婴儿血管瘤中常见的、主要为良性的并发症，但对于溃疡性 CH 的预后知之甚少。然而，已经观察到溃疡性 CH 可能会导致危及生命的出血事件。
我们报告了 2 例溃疡性快速消退先天性血管瘤（RICH），这些病例在新生儿期出现危及生命的出血事件。在这两种情况下，CH 均由高流量血管供血，随后发生的大量出血是由于溃疡引起的浅层血管壁侵蚀。两名患者均通过血管内栓塞成功治疗；一名患者还接受了止血手术。
这 2 个病例强调了密切监测溃疡性 CH 患儿的重要性，因为存在严重出血的风险。在发生严重出血的情况下，栓塞是首选治疗方法，因为 RICH 的自然病程是自发消退。
