Capillary hemangioma of parotid gland in a child

Clinical History

A 19-month-old girl presented with a mobile, painless mass on her right cheek. The size of the mass had increased gradually since birth and a there was a bluish skin discolouration over the lump. There was no evidence of inflammation or infection on her physical or laboratory examinations.

Imaging Findings

Grey scale ultrasound demonstrated a homogeneous lobulated mass within fine echogenic internal septations enlarging the right parotid gland (Fig. 1a). Colour Doppler showed the lesion to be hypervascular and infiltrating the right parotid gland (Fig. 1b).

MRI of the face confirmed a well-defined mass of intermediate signal in the right parotid region on T1-W images (Fig. 2a), with the mass having high signal intensity and flow voids on fat suppressed T2-W images (Fig. 2b). Following IV contrast administration the mass enhanced intensively (Fig. 2c).

Discussion

Infantile haemangiomata are a type of vascular neoplasm, and are the most common tumour of infancy being found in approximately 4%-10% of infants [1]. They typically present between 2 weeks and 2 months of life in a proliferative phase, gradually involuting over the following 1-7 years, with complete regression by around 8 years of age. They may be located in the head and neck (60%), trunk (25%) or extremities (15%) [2]. Infantile haemangiomata are diagnosed by the use of high frequency ultrasound transducers, where they are seen as well-defined, solid, homogeneous masses of variable echogenicity. The masses are hypervascular with colour Doppler, with both arterial and venous waveforms and high Doppler shift. On MRI they have iso-to-intermediate signal on T1W and increased signal on T2W images, with internal flow voids. They always show homogeneous contrast enhancement. Follow-up imaging is useful to show lesion regression over time.

Ulceration is the most common complication. Complication risk increases with size and location [1, 2]. Although they regress over time, treatment options may be a choice for haemangiomata depending on the type and severity of complications, including laser therapy and medical management with anti-angiogenic drugs, to embolisation, surgery, and rarely, organ transplant. Propranolol is the most commonly prescribed drug that is used for the medical treatment [2].

Differential Diagnosis List

Final Diagnosis

Infantile haemangioma of parotid gland

URL:	https://www.eurorad.org/case/12368
DOI:	10.1594/EURORAD/CASE.12368
ISSN:	1563-4086