Simplified Thrombosis of a Large, Hypertrophic Hemangioma of the Scalp

Abstract

The natural history of the small hypertrophic hemangiomas of infancy is well knownY .3 They increase in size up to about 4 months or until the end of the first year and then decrease with mottling of the mass and a gradual disappearance of color. By the fifth year most of them have disappeared or have become insignificant. The natural history of the large hypertrophic hemangiomas is now also well known, and their prognosis is quite a different matter. 4,6-12 The size at birth is not the best criterion for differentiation between the two types. Some of the large tumors have not been observed at birth, 7 or have been no more than a bluish discoloration at birth. 12 Others have been as large as a tennis ball. 4 In most there has been no tendency to bleeding at birth and several infants have been circumcised without incident, s.12 Thereafter two things may happen: the tumor increases rapidly in size and thrombocytopenia purpura develops. It is presumed that platelets are consumed by the rapidly growing tumor and thrombi of platelets have been found in them. 7 In some instances a tendency to bleeding has been present very early. The patient of Southard et al. n had bloody diarrhea on the second day, and enlargement of the mass which had been 4 cm. in diameter was not noted until the tenth day. It is more usual to note an enlargement before bleeding commences s and in some enlargement and purpura appear simultaneously. 4 In most instances these difficulties have arisen within the first few months of life, but here again there is some variation and in the case of Scherz et al. 9 they were not present until the patient was 1 year old. Growth of the tumor may be very rapid and very extensive and may easily simulate a malignant neoplasm. In the case of Silver et al., ~~ which commenced with a small elevated vascular area behind one ear (and which ended fatally), the tumor spread over the neck, chest, back and arms. In the second case of Good et al., r which commenced with a small, red birthmark on the medial aspect of the knee, it spread to involve the entire leg. Illustrations in that paper show the really remarkable extent to which such lesions