Extensive Facial Hemangiomas With Serious Associated Systemic Abnormalities

Mohamed A.W. Hussein, MD; David K. Coats, MD; Denise W. Metry, MD Series Editor: David K. Coats, MD


October 07, 2002

Clinical Course

The child was believed to be at high risk for developing amblyopia. Treatment with oral prednisone was initiated by her dermatologist for both the ophthalmologic and nonophthalmologic hemangiomas. Despite systemic steroids, the right upper eyelid hemangioma continued to rapidly enlarge, which caused it to begin to encroach on the visual axis. An intralesional steroid injection consisting of a 50/50 mixture of betamethazone 6 mg per mL and triamcinolone acetate 40 mg per mL was administered to the lesion in the right upper lid at 2.5 months of age.

Following steroid injection, the lesion stabilized for a period of 2 months. During this period, the child was continued on oral steroids to treat associated nonophthalmologic hemangiomas. The right upper lid lesion began to enlarge again following oral steroid taper, prompting a repeat injection of intralesional steroids at approximately 6 months of age. The lesion decreased in size, clearing the visual axis and reducing the risk of deprivational amblyopia (Figure 1). Prophylactic part-time occlusion of the left eye was recommended. Since then, the child has not developed amblyopia.

Figure 1.

Note extensive hemangioma involving right lids and nose. Hemangiomas are also present on the left lids, lip, and in the right orbit.


Cardiology consultation diagnosed a large ventriculoseptal defect (VSD). An abdominal magnetic resonance imaging (MRI) scan revealed multiple hepatic hemangiomas involving the right lobe (Figure 2).

Figure 2.

Abdominal magnetic resonance imaging showing multiple hemangiomas involving the right lobe of the liver (arrow).


MRI of the brain was normal, although magnetic resonance arteriography demonstrated anomalous cerebral vasculature and anatomic abnormalities in the course of the carotid arteries (Figure 3). The VSD defect was surgically closed.

Figure 3.

Magnetic resonance arteriography of the brain demonstrating anomalous cerebral vasculature.