Complications

Although rare, complications of hemangiomas dictate a need for treatment. A partial list of these complications includes:

1. Ulceration (figure 3)

2. Airway Obstruction

3. Visual Loss: Obstruction of the visual axis for one week in the first year of life can cause permanent amblyopia.

4. External auditory canal obstruction (figure 3)

5. Heart failure: This is usually manageable by medical therapy in combination with some attempt to manage the growth of the hemangioma. Fluid restriction, diuretics and other recommendations from the cardiologist are usually adequate to control heart failure. Steroids and interferon, as discussed below, are the initial therapies to attempt to halt the growth of the hemangioma. Surgical therapy and embolization are a second tier of therapy. Radiation is reserved for failure of all other therapies.

6. Bleeding: This is usually low-flow and can be managed simply with pressure

7. Kasselbach-Merrit syndrome: Hemangiomas lager than 5cm may begin to trap platelets, resulting in profound thrombocytopenia (<10,000 platelets/mm3). These trapped and degrading platelets lead to a secondary consumption of clotting factors, resulting in potentially life threatening coagulapathy. This process may in some way release growth factors, which in turn stimulate more rapid growth of the hemangioma, causing a cyclical process that may result in death.