Sonographic Findings in a Series of Rapidly Involuting Congenital Hemangiomas (RICH)

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Abstract
We report 10 patients with lesions consistent with the clinical entity of rapidly involuting congenital hemangioma (RICH). These are congenital vascular tumors bearing some resemblance to infantile hemangiomas, but with important clinical differences. The lesions in our patients were firm, red or purple plaques or tumors, sometimes with surface telangiectasia and almost all with a pale or blanched halo. They were fully developed at birth and underwent no further expansion. All promptly began to resolve and this progressed rapidly over the early months of life, with complete resolution, sometimes with residual atrophy, occurring at less than 1 year of age in most of the patients. Sonography was performed in all of our cases. A remarkably consistent picture was demonstrated. The lesions were uniformly hypoechoic and mostly confined to the subcutaneous fat. They were diffusely vascular, being traversed by multiple tubular vascular channels. Some of the channels were compressible, with a venous flow signal, while others demonstrated low resistant arterial flow. These features are consistent with recently described histopathologic findings in these rapidly involuting lesions. We feel that this entity can be reliably diagnosed in most cases with a consideration of the unique clinical features and with the use of noninvasive imaging studies.