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

Vascular malformations
Vascular malformations are the second large class of ISSVA 
classification [
6
]. They are a heterogeneous group of con-
genital lesions present at birth but sometimes not clinically 
evident [
39
]. They tend to grow slowly in proportion to 
the patient, although some conditions—trauma, hormo-
nal changes, internal bleeding, and pregnancy—can lead 
to sudden and tumultuous growth [
1
, 
39
]. The revision of 
the ISSVA classification of 2018, confirming when already 
proposed in 2014, divides vascular malformations into four 
categories: simple, combined, of a major vessel, and associ-
ated with other anomalies. These categories are based on the 
presence of one or more types of vessels combined with each 
other in the same lesion.
Here we will deal mainly with 
simple malformations
, 
which are in turn divided into further categories according 
to the vessels involved: capillaries, venous, lymphatic, and 
arteriovenous.
Fig. 10
Kaposiform hemangioendothelioma in a 2-day-old girl. The 
“extended view” sonogram shows a large subcutaneous mass of the 
abdominal wall (arrows). The mass is heterogeneous with some ves-
sels visible on the gray-scale image. 
L
liver, 
S
spleen
Fig. 11
Kaposiform hemangioendothelioma in a 2-day-old girl. Color 
Doppler sonogram confirms the high vascular density of lesion

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19
Journal of Ultrasound (2019) 22:13–25 
1 3
From a practical point of view, it is useful to distinguish 
vascular malformations on the basis of Mulliken’s proposal 
[
1
, 
5
] according to their behavior to the spectral analysis 
in 
high
-
flow lesions
and in s
low
-
flow lesions
. The former 
always provide for the presence of arteries and often can be 
difficult to distinguish from vascular tumors such as infantile 
hemangioma [
14
].