Pediatric emergency medicine trisk 1342 1342
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bronchospasm, and hypothermia; however, overall safety, even in young infants,
has been good.
Although most lesions generally involute with little to no complications given
time, certain hemangiomas pose potential risks based on their anatomic location.
Rapidly enlarging hemangiomas near the eyes ( Fig. 69.15 ) may result in
amblyopia through obstruction of the visual axis (deprivation amblyopia) or
because of the compression of the eyeball itself (strabismus or anisometropia) and
require prompt intervention with systemic propranolol, steroids, or sometimes
surgery. Hemangiomas in a “beard” distribution—around the mouth, preauricular
areas, chin, or anterior neck—may indicate the presence of airway hemangiomas
and warrant further evaluation by direct laryngobronchoscopy or radiologic
imaging studies. Hemangiomas overlying the midline lower back may represent
markers for spinal dysraphism or tethered cord syndrome and warrant imaging.
Finally, large, segmental facial hemangiomas have been associated with
PHACE(S) syndrome, in which children suffer from P osterior fossa
malformations; facial H emangiomas; A rterial anomalies, including coarctation
of the aorta; structural C ardiac malformations; E ndocrinologic and structural E
ye abnormalities; and midline S ternal defects or supraumbilical raphe.
Intracranial vascular anomalies may predispose this subset of these children to an
increased risk for stroke. The corollary in the pelvic region is called LUMBAR
syndrome (lower body hemangioma and other cutaneous defects, urogenital
anomalies, ulceration, myelopathy, bony deformities, anorectal malformations,
arterial anomalies, and renal anomalies). These patients can also be at risk for
arterial as well as other urogenital and bony abnormalities ( Table 69.1 ).
