Eur J Pediatr Surg 2010; 20(6): 379-381
DOI: 10.1055/s-0030-1261938
Original Article

© Georg Thieme Verlag KG Stuttgart · New York

Multiple Hemangiomas and Hemangiomatosis – Risk Factors and Outcome over an Eight Year Period

C. J. Schupp1 , S. Holland-Cunz1 , J.-P. Schenk2 , H. Weisser3 , D. Grimm4 , P. Günther1
  • 1University Hospital Heidelberg, Division of Pediatric Surgery, Heidelberg, Germany
  • 2University of Heidelberg, Department of Pediatric Radiology, Heidelberg, Germany
  • 3University Hospital Heidelberg, Dermatology, Heidelberg, Germany
  • 4University Hospital Heidelberg, Pediatrics, Heidelberg, Germany
Weitere Informationen


received May 05, 2010

accepted after revision May 15, 2010

27. Juli 2010 (online)


Introduction: Hemangiomas are the most common tumors of infancy. Multiple cutaneous hemangiomas may be associated with the presence of hemangiomas in inner organs. However, there is little data on the risk factors for organ involvement and the outcome of a large sample of patients.

Patients and Methods: patients with 3 or more cutaneous hemangiomas were evaluated with regard to patient characteristics, distribution of hemangiomas, results of radiological abdominal/cerebral imaging, clinical course, and therapeutic approach. We analyzed the risk factors for organ involvement and complications/outcome.

Results: The average gestational week at birth was 32.8; radiological imaging showed liver hemangiomas in 13.5% and mesenteric lesions in 1 (1.9%) but no cerebral lesions. Preterm infants (p=0.02) and patients with high numbers of cutaneous hemangiomas (p=0.02) were at higher risk of organ involvement. A life-threatening event occurred in 1 patient (1.9%). None of the patients died.

Conclusions: Organ manifestation is relatively common in patients with multiple hemangiomas, complications are rare, but potentially life-threatening. We recommend abdominal imaging for patients with 3 or more hemangiomas, especially in preterm infants.


  • 1 Boye E, Yu Y, Paranya G. et al . Clonality and altered behavior of endothelial cells from hemangiomas.  J Clin Invest. 2001;  107 745-752
  • 2 Smolinski KN, Yan C. Hemangiomas of Infancy: Clinical and Biological Characteristics.  Clin Pediatr. 2005;  44 747-766
  • 3 Willenberg T, Baumgartner I. Vascular Birthmarks.  Vasa. 2008;  37 5-17
  • 4 Dufau JP, le Tourneau A, Audouin J. et al . Isolated diffuse hemangiomatosis of the spleen with Kasabach-Merritt-like syndrome.  Histopathology. 1999;  35 337-344
  • 5 Mridha AR, Chopra A, Chopra P. et al . Diffuse neonatal hemangiomatosis without cutaneous involvement.  Acta Paediatr. 2006;  95 763-764
  • 6 Schulz AS, Urban J, Gessler P. et al . Anaemia, thrombocytopenia and coagulopathy due to occult diffuse infantile hemangiomatosis of spleen and pancreas.  Eur J Pediatr. 1999;  158 379-383
  • 7 Lopriore E, Markhorst DG. Diffuse neonatal hemangiomatosis: new views on diagnostic criteria and prognosis.  Acta Paediatr. 1999;  88 93-97
  • 8 Boon LM, MacDonald DM, Mulliken JB. Complications of systemic corticosteroid therapy for problematic hemangioma.  Plast Reconstr Surg. 1999;  104 1616-1623
  • 9 Darper H, Diamond I, Temple M. Multimodal management of endangering hepatic hemangioma: impact on transplant avoidance: a descriptive case series.  J Pediatr Surg. 2008;  434 120-126
  • 10 Ethundan M, Mellor TK. Hemangiomas and vascular malformations of the maxillofacial region – a review.  Br J Oral Maxillofac Surg. 2006;  44 263-272
  • 11 Gottschling S, Schneider G, Meyer S. et al . 2 infants with life-threatening diffuse neonatal hemangiomatosis treated with cyclophosphamide.  Pediatr Blood Cancer. 2006;  46 239-242
  • 12 Isaacs H. Fetal and neonatal hepatic tumors.  J Pediatr Surg. 2007;  42 1797-1803
  • 13 Léauté-Labrèze C, Dumas de la Roque E, Hubiche T. et al . Propranolol for severe hemangiomas of infancy.  N Engl J Med. 2008;  358 2649-2651
  • 14 Sadan N, Wolach B. Treatment of hemangiomas of infants with high doses of prednisone.  J Pediatr. 1996;  128 141-146
  • 15 Stillman AE, Hansen RC, Hallinan V. et al . Diffuse neonatal hemangiomatosis with severe gastrointestinal involvement Favorable response to steroid therapy.  Clin Pediatr. 1983;  22 589-591
  • 16 White CW. Treatment of hemangiomatosis with recombinant interferon alfa.  Semin Hematol. 1990;  27 15-22
  • 17 Rohana J, Boo NY, Hayati AR. et al . Diffuse neonatal hemangiomatosis: a rare cause of haemorrhagic shock and refractory coagulopathy in the newborn.  Med J Malaysia. 2006;  57 364-367
  • 18 Golitz LE, Rudikoff J, O'Meara OP. Diffuse neonatal hemangiomatosis.  Pediatr Dermatol. 1986;  3 145-152
  • 19 Enjolras O, Riche MC, Merland JJ. et al . Management of alarming hemangiomas in infancy: A review of 25 cases.  Pediatrics. 1990;  85 491-498


Dr. Christine Johanna Schupp

University Hospital Heidelberg

Pediatric Surgery

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69117 Heidelberg


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