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Hemangioma vs. Vascular malformation, that is the question!

Hemangiomas are often misdiagnosed with vascular malformations and vice-versa. In this blog, we will shed some light into this and clarify some concepts.

 A hemangioma is a vascular tumor, arising exclusively in infancy, is composed of rapidly proliferating vascular endothelium and is characterized by a proliferative, stabilizing and involuting phase.

A hemangioma has 3 phases:

1) Proliferative Phase (0-1 year): rapidly proliferating plump of endothelial (“vessels”) cells. It presents with a rapidly growing bright red lesion

2) Involuting phase (1-7 years): Grows in proportion with child. Bright crimson color fades to a dull purplish blue. Skin pales at the center and a patch gray mantle forms. By palpation is less tense. Last traces of color: age 7.

3) Involuted phase (>7years): 50% near normal skin. Otherwise involved skin: telangiectasias, crepe-like laxity (destruction of elastin), yellowish discoloration or scarred patches (ulcerated lesions). Fibro fatty residuum and redundant skin if tumor large and protuberant. Scalp lesions destroy hair follicles.


A Vascular Malformation is due to an error of vascular embryonic development, can be present at birth and growing proportionally with the body, composed of dysmorphic channels lined by mature endothelium with an exceedingly slow rate of turnover and no natural involution. Children are usually born with them.

Vascular malformations are classified based on the type of vessels involved. There are arterial malformations, venous malformations, lymphatic malformations, capillary malformations as well as combinations such as arteriovenous malformations or venolymphatic malformations.

Vascular malformations are also classified based on hemodynamic and lymphodynamic characteristics: High flow: arterial (AM), arteriovenous (AVM), arteriovenous fistula. ii. Low flow: venous (VM), capillary (CM), lymphatic (LM).

Clinical features of High flow lesions (AM, AVM) include:

  • Hemodynamically active = pulsations, bruits, thrills.
  • Expansion when Blood Pressure or blood flow rise
  • Collateral formation with trauma or surgery

Clinical features of Low flow lesions (CM, LM, VM) include

  • Hemodynamically less active = venous bruit, no thrills
  • More edematous
  • Can combine elements of all three lines (arterial,venous and lymphatic)

If you have any questions with regards to the birthmark of your child, feel free to visit us and talk to Dr. Tahiri about it.


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