Live Blog: Vascular Conditions in Pediatric Populations – Faculty: Howard Pride, MD
In this live blog from the Annual Summer SDPA Conference in Las Vegas, Howard Price, MD, presented a lecture on “Vascular Conditions in Pediatrics.” Here are some of the highlights.
Dr. Pride focused his lecture on diagnosing and treating hemangiomas. He explained that 80% of the hemangioma size is reached by 3 months, adding that “the rapid growth appears early on and growth ends at 9 months.” He noted that while the size is set, the amount the growth will bulge is undeterminable. This growth information can assist in planning treatment.
A large determining factor for which treatment route to take, said Dr. Pride, was the location of the lesion. Mandibular hemangiomas put the child at risk for airway obstruction and segmental distribution is the most likely to have associated complications. Simply put: “Location is not random.”
Once location is considered treatment can be broken down to three factors: treat the danger (such airway obstruction), treat the impending ulceration, and treat the cosmetic disfigurement. The hemangiomas for which surgery is most appropriate are those that show a large bulb and a little stalk. The threshold is different in light of the safe and effective use of propanalol. Before prescribing propanalol, make sure to note that to the parents that the drug often causes nightmares. Propanalol should be prescribed to patients that are eating well, as hypoglycemia is listed as an adverse event.
When determining treatment plans, it is important for medical providers to know the difference between a hemangioma, a Noninvoluting Congenital Hemangioma (NICH), and a Rapidly Involuting Congenital Hemangioma (RICH). NICH are rare cutaneous vascular anomalies typically found on the head, neck, limbs, and trunk. These do not go away on their own, and if therapy is desired, surgical excision is the treatment of choice. RICH are fully grown at birth with no post-natal growth. These tend to have a rapid involution in the child’s first year. One way to tell RICH/NICH apart from hemangiomas is in the low levels of IGF-2 in RICH/NICH compared to proliferative hemangiomas. There is growing evidence that these two are biologically distinct.
“You can’t design an algorithm for treatment,” Dr. Pride confessed. Consider the age of the patient, the size and location of the growth, and any ulceration as you decide which path to take. And never be afraid to consult with a trusted colleague.
Image: Stewart Butterfield