Case#10

History: Infant with soft tissue prominence and small skin discoloration in the thumb. 

• MRI (see below): T2 weighted axial image shows a non-specific hyperintensity in the area (1st MR image). T1 weighted axial  MRI demonstrates a slightly hyperintense (relative to the muscles) lesion in the thumb (2nd image). Post-gadolinium T1 weighted image shows some contrast enhancement in the lesion. 

Diagnosis: Infantile Hemangioma. 

Discussion: MRI is limited in this case; because the area of interest (thumb) is a small body part and the lesion is also small in size. In most larger infantile hemangiomas, MRI can be more helpful in terms of confirming the suspected diagnosis and also to outline the margins of the malformation. Most large infantile hemangiomas demonstrates relatively homogeneous contrast enhancement and some small fast-flow vascularity in the periphery of the mass, as well as in the surrounding soft tissues. Overall, rare possibilities (e.g., malignancy) can not be entirely excluded in this case based on this MR scan. To learn more about MRI scan for these conditions, click here. Final decision should be made based on clinical history and assessment.

Treatment: Assuming this is a small infantile hemangioma, no treatment is needed. No arteriogram is required. If lesion enlarges significantly unusual to a typical infantile hemangioma, biopsy may be indicated. This should should involute in the next few years with or without minimal sequela. No sclerotherapy or embolization is indicated.