Classification and ultrasound findings of vascular anomalies in pediatric age: the essential

Fig. 1
Infantile hemangioma: proliferative phase in a 5-week-old boy. 
The lesion healed after treatment with propanol
Fig. 2
Infantile hemangioma. 
a
Sonogram shows hyperechoic pattern, 
8-month-old girl; 
b
sonogram shows hypoechoic lobulated pattern, 
5-month-old girl

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Journal of Ultrasound (2019) 22:13–25
1 3
(Fig. 
5
). It is also possible to identify venous vessels that 
show slow flow and are generally poorly modulated [
14
].
Normally, infantile hemangioma is not often examined 
in the 
involutive phase
. In this stage, the echogenicity of the 
lesion increases progressively, due to the increase in adipose 
tissue and at the same time decreases the vascular density 
with arterial flows which show a progressive increase in the 
Resistive Index (RI) [
7
, 
9
, 
20
, 
21
].
Congenital hemangioma
Congenital hemangioma is by definition already present at 
birth. Introduced for the first time in 1996 [
22
, 
23
], con-
genital hemangioma, although presenting vascular charac-
teristics similar to infantile hemangioma, is differentiated 
by clinical history and histopathological aspects [
12
, 
24
, 
25
]. These lesions grow rapidly in the uterus, so they are 
very evident at birth (Fig. 
6
). Based on their evolution 
they are distinguished in 
rapidly involuting congenital 
Fig. 3
Color Doppler sonogram 
shows high vascular density, 
characteristic of infantile 
hemangioma
Fig. 4
Infantile hemangioma in 4-month-old girl. B-flow technology 
shows the very high vascular density