Differential Diagnosis

The typical diagnostic alternative to consider when attempting diagnose a lesion as a hemangioma is a vascular malformation. Typically, the child who ultimately proves to have a hemangioma appears normal at birth and develops rapidly increasing symptoms in the subsequent weeks to months, that leads to diagnosis. Classically, a vascular malformation is present at birth and evolves slowly, as the patient grows. Consequently, it should then be obvious that a single physical exam may be inadequate to establish a diagnosis, and may require serial exams or radiologic confirmation.

One lesion, which is not a vascular malformation, which bears special mention, as it is often confused with a hemangioma, is a pyogenic granuloma. A pyogenic granuloma is often the result of a minor trauma. The lesion is usually sessile and as it grows becomes pedicled, often bleeding impressively, prior to definitive surgical management.

Magnetic resonance imaging (MRI) with contrast is the most useful of all radiologic evaluations of vascular malformations or hemangiomas. Typical MRI can differentiate a hemangioma from a vascular malformation and will also typically identify the type a vascular malformation. A discussion of clinical suspicions with the radiologist may help determine the need for concomitant magnetic resonance angiography, which is especially helpful in locating feeder vessels of high flow arteriovenous malformations.

The ultimate method of differentiating all diagnostic possibilities is with histologic study of the tissue. A biopsy should be done whenever there is a possibility that the lesion in question is a malignant tumor; however, a biopsy is rarely necessary, as there are usually ample empidemiologic, clinical, and radiologic clues, which can facilitate a reliable diagnosis.