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(A) Selected gray scale and (B) color Doppler imaging from an ultrasound performed of the vascular mass demonstrates innumerable fluid-filled structures throughout the mass which are proven to represent profound vascularity, as reflected by the marked flow seen on (B).
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Antenatal scan at 20 weeks revealed a vascular mass on the right thigh, 3.6 x 2.9 x 2.3 cm, composed of multiple small cysts with marked engorgement of right iliac and superficial femoral arteries (Fig. 1A). Color Doppler images demonstrate the vascularity of the lesion (Fig. 1B).
PMC4737636_02
(A and B) Two images from a coronal maximum intensity projection and (C) a single right posterolateral image from a three-dimensional reformat, created from a computed tomography angiogram, demonstrate massive enlargement of the right iliofemoral arterial (solid arrow) and venous (dashed arrow) circulation. The hypervascular mass representing the rapidly involuting congenital hemangiomas is well appreciated (asterisk), with the arterial circulation beyond the mass returning to a normal caliber (small dashed arrows).
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Computed tomography angiogram on day 4 of age allowed to better characterize the congenital hemangioma involving the right medial and anterior upper thigh with innumerable large tortuous arteries and draining veins (Fig. 2).
(A) Early arterial and (B) parenchymal/venous phase images from the first endovascular embolization procedure demonstrate marked enlargement of the right superficial femoral artery (solid arrow), with marked lesional blush and dilation of the associated venous circulation (dashed arrow).
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He underwent intra-arterial embolization on the 8th day of age via umbilical arterial access, with coil embolization of several of the large feeding arteries to the hemangioma (Fig. 3) using detachable neurovascular coils (Axium; Medtronic, Brampton, Ontario, Canada) delivered through an Excelsior SL-10 microcatheter (Stryker Neurovascular, Hamilton, Ontario, Canada).
Plain film imaging after the second embolization demonstrating the platinum coils used for endovascular embolization of feeding arteries to the rapidly involuting congenital hemangiomas.
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As the possibility of an additional procedure was considered after the first embolization, umbilical arterial access was maintained and the baby underwent repeat transarterial coil embolization on day 12 of age to further reduce the blood flow through the hemangioma (Fig. 4).
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Image of the resolved lesion and both limbs at follow-up visit (19-month corrected age).
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At 19-month CA, our patient was noted to have equal leg lengths, although the distal and proximal thigh circumferences were 0.5 cm larger on the right (side of the RICH) than the left (Fig. 5).