Case#13

History: Newborn with an obvious lesion in the thigh. Etiology is unclear.

1st photo is at birth and 2nd photo obtained a week later.

Discussion: This is a congenital lesion and the differential should include congenital hemangioma (or rapidly involuting congenital hemangioma - RICH) or congenital sarcoma. Congenital sarcoma (fibrosarcoma) is probably less common than RICH. Diagnosis of RICH was made based on the lesion's appearance. Imaging (typically MR or US) may be indicated to confirm the diagnosis. Biopsy of the lesion may also be needed in selected cases. Platelet count and thyroid hormone levels needs to be checked. Imaging findings of this condition may be quite confusing; probably this has caused unnecessary interventions in many patients throughout the country. If needed, transcatheter embolization is the treatment of choice to close off some of the arterial feeders, and surgery is required in small number of patients. Medical management (drug therapy) is similar to infantile hemangioma. 

1st photo obtained at 3 months and the 2nd photo obtained at 5 months. 

Diagnosis: RICH (Congenital hemangioma or Rapidly Involuting Congenital hemangioma)