A hemangioma is a benign growth in the blood vessels. Blood sponges appear in newborns or show up within the first few months of life. When a blood sponge needs to be removed and which therapy is possible.
- A hemangioma is found in newborns or forms in the first few months of life.
- © iStock.com/martinedoucet
A hemangioma (blood sponges, blood sponges) occurs when the baby's vascularization is disturbed during pregnancy. The change is usually not or barely visible at birth. Blood sponges are found in eight to twelve percent of all infants.
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What is a hemangioma?
The hemangioma is a benign tumor that results from an overgrowth of the innermost wall of the blood vessels. It forms due to immaturity of the vascular system and is the most common benign tumor in childhood. Other names for a hemangioma are blood sponges, blood sponges, infant hemangiomas, or strawberry angiomas. A blood sponge can be present from birth (congenital hemangioma) or develop in the first few weeks of life (infantile hemangioma).
What do hemangiomas look like?
Blood sponges usually reach a size of several millimeters to two centimeters. In extreme cases, they are also more than ten centimeters tall. In 60 percent of cases they occur in the head and neck area, 25 percent of the blood sponges are located on the trunk, less often on the arms and legs.
In 80 percent of an affected child there is only one hemangioma, only a few children have two or more blood sponges at the same time. In addition to the surface of the body, hemangiomas can also develop on internal organs, especially the liver, lungs, digestive tract and brain, as well as the spine.
Most hemangiomas are made up of the smallest blood vessels (capillaries). They lie very superficially in the skin, are regularly limited and bulge in the form of bulging, elastic nodes. Because of their intense red color, they are also called strawberry angiomas.
A smaller part of the hemangioma consists of large, irregularly shaped and blood-filled cavities. They usually lie deeper in the subcutaneous fatty tissue and form soft, light red to blue-red, flat knots.
Very often there is a combination: In this case one sees a bluish, flat blood sponge, in the middle of which a small, intense red lump bulges the skin surface strongly.
How do the phases of the blood sponge go?
A hemangioma goes through three phases. If blood sponges heal completely, a recurrence is impossible. The deeper the hemangioma is under the skin, the longer it takes to regress.
Growth phase: Takes six to nine months. The hemangioma grows flat and forms thickenings under the skin. It grows very quickly, especially in the first three to four months, after which it slows down.
Standstill phase: The length of this phase can stretch over months to years.
Recovery phase: After the growth arrest, the hemangioma gradually changes color. The intense red fades, the blood sponge becomes gray-reddish, then gray and finally skin-colored. It gets softer and flatter.
Rash: what is the underlying disease?
What is a liver hemangioma?
Blood sponges on internal organs are usually harmless and are only discovered by chance. Hemangiomas that are a maximum of five centimeters in size and do not cause any problems can occur in the liver. Most of those affected are between 30 and 50 years old when diagnosed.
If the blood sponges get bigger, they can be the cause of unspecific complaints. In the case of a liver hemangioma, symptoms can be in the upper abdomen or they can trigger epileptic seizures in the brain, for example. Bleeding from internal hemangiomas is rare.
Blood sponges can lead to complications
Nine out of ten hemangiomas do not cause complications. In the remaining cases, serious consequences can occur:
Ulcers: An ulcer can form in the area of the blood sponges, which harbors the risk of bleeding, pain, tissue death and infections.
Hemangiomas of the eye: Blood sponges on the eyelid or directly on the eye can affect the eye opening. A very large hemangioma can press on the eyeball in this area and cause one-sided myopia, strabismus, or blindness.
Hemangiomas of the mouth: If a blood sponge sits on the lips or directly on the mouth, it can lead to problems with food intake. Permanent deformation of the lips or jaw as well as misaligned teeth can be triggered in this way. If the lining of the mouth and throat around the windpipe are affected, the hemangioma can lead to breathing problems.
Hemangiomas on the nose: Here a hemangioma can lead to deformation of the nasal skeleton. This hinders nasal breathing and the shape of the nose can change.
Hemangiomas on the ear: Changes in the auricle and the ear cartilage can occur.
Very large and extensive blood sponges: Such blood sponges put a heavy strain on the heart and circulation, so that over time it can lead to heart failure. Blood clotting disorders and spontaneous bleeding are also possible.
Hemangiomas of internal organs: Very rarely, large blood sponges cause internal bleeding.
This is how the doctor diagnoses a hemangioma
Doctors can diagnose most hemangiomas by taking a thorough medical history, looking at the blood vessels, and palpating the blood sponges and their surroundings. Further examinations serve to determine the activity of the hemangioma, the exact development phase and its exact size. This allows the doctor to rule out possible complications and, if necessary, draw up a treatment plan.
After a photo documentation, the doctor will use an ultrasound scan to determine whether internal organs are involved. If a hemangioma is larger than ten centimeters, cardiac insufficiency and the risk of bleeding must be excluded by a blood count with coagulation values. If the ultrasound results are not meaningful enough, magnetic resonance imaging (MRI) or computed tomography (CT) will bring clarity.
To make sure that there is no airway involvement in hemangiomas of the lower half of the face, the doctor can perform a lung specimen (bronchoscopy). A tissue examination (biopsy) is only carried out if there is a suspicion of cancer.
When does a hemangioma need to be removed?
Most blood sponges do not need treatment because they are uncomplicated and regress on their own. No removal or treatment of the hemangioma should be performed during the regression phase. It is better then to wait for complete recovery.
The following therapies are available:
Cryotherapy: Icing with cold bars (-30 to -40 degrees Celsius) or liquid nitrogen (-196 degrees Celsius) can be used without anesthesia. The procedure reduces the growth of the hemangioma and stimulates its regression. Several treatments are often required every few weeks and scarring is rare.
Laser therapy: The laser obliterates hemangiomas and reduces their size. Anesthesia or anesthesia must be used beforehand, as laser treatment is very painful.
Surgery: Surgical removal of the blood sponges is rarely necessary and useful. Many hemangiomas recur after surgery, and the complications from scarring are often significant. However, if other treatments are unsuccessful or if there is a risk of loss of eyesight, for example, an operation may be inevitable.
Medication: Propranolol and cortisone are drugs that have been used successfully to treat hemangiomas. In the case of a very large blood sponge, in particular, the administration of the antihypertensive propranolol alone or in combination with cortisone can reduce the hemangioma. Both drugs have significant side effects, so that the medication must usually be discontinued in an inpatient setting. Cortisone can also be used as an ointment.
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