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Review
. 2015 Dec;5(6):886-97.
doi: 10.3978/j.issn.2223-4292.2015.04.06.

Vascular anomalies of the head and neck in children

Kate Mahady  1 , Stefanie Thust  1 , Rupert Berkeley  1 , Sam Stuart  1 , Alex Barnacle  1 , Fergus Robertson  1 , Kshitij Mankad  1
Affiliations
Review

Vascular anomalies of the head and neck in children

Kate Mahady et al. Quant Imaging Med Surg. 2015 Dec.

Abstract

Sixty percent of vascular anomalies in children are found in the head and neck. These lesions can present throughout antenatal, perinatal and childhood development. They broadly fall into two categories: vascular tumours and vascular malformations. Their clinical and, often, psychological impact is determined by both pathological type and location: many lesions follow an uncomplicated natural course and other more complex, extensive or progressive lesions can present a threat to life from mass effect, haemorrhage or large volume arteriovenous shunting. Vascular tumours include infantile haemangioma (IH), congenital haemangioma (CH) and kaposiform hemangioendothelioma (KH); of which IH is the most common. Management options for vascular tumours include conservative approaches, oral medications and surgical intervention as determined by tumour type, location and associated complications. Vascular malformations can be categorised into low flow and high flow lesions. Low flow lesions include capillary, venous and lymphatic malformations (LMs). High flow lesions describe the arteriovenous malformations (AVMs), a highly heterogeneous group of lesions which can present in a variety of ways-the mainstay of treatment for these dynamic lesions is endovascular or surgical obliteration. We provide a practical framework for clinical classification of vascular anomalies of the head and neck in children. We also explore principles of their clinical and radiological assessment along with management, highlighting the importance of a multi-disciplinary approach.

Keywords: Vascular; arteriovenous; birthmark; haemangioma; infantile; kaposiform; malformation.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Infantile haemangioma on the face with orbital extension. Note the typical high vascularity demonstrated on colour Doppler ultrasound assessment.
Figure 2
Figure 2
PHACES syndrome with multifocal facial haemangioma, narrowing of the internal carotid artery and unilateral phthisis bulbi. PHACES syndrome: posterior fossa malformation; haemangioma of the face or neck; arterial stenosis, aneurysm or occlusion; cardiovascular anomalies; eye abnormalities; sternal cleft and supra-umbilical raphe.
Figure 3
Figure 3
Congenital right-sided orbital haemangioma. Note the homogenous avid enhancement (high T1 signal), which is typical.
Figure 4
Figure 4
MRI and right external carotid injection DSA demonstrating kaposiform hemangioendothelioma. MRI, magnetic resonance imaging; DSA, digital subtraction angiography.
Figure 5
Figure 5
Sturge-Weber syndrome with typical features of enhancing pial angioma and unilateral cerebral hemispheric atrophy. Also note associated thickening of the ipsilateral skull vault.
Figure 6
Figure 6
Venous malformation adjacent to the left mandible. Note the low signal foci within the lesion representing phleboliths.
Figure 7
Figure 7
Extensive facial lymphatic malformation. In a lesion this large there is risk of airway compromise (note the narrowed trachea ‘T’).
Figure 8
Figure 8
Arteriovenous malformation of the right side of the face with feeding vessels from the right anterior branch of the maxillary artery which was treated with endovascular glue injection. The subsequent DSA demonstrates improved appearances. DSA, digital subtraction angiography.
See this image and copyright information in PMC

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