Q: My son is 10 months old. He has congenital hemangioma in left leg. He has red patches in area around his thighs and the calf region with small blackish moles. He is a growing child with all normal activities. Since he is learning to crawl, he scratches the affected portion and it bleeds. The whole leg along with buttock is heavier than the other one. We need an appropriate doctor who can help us with the treatment. Please suggest.

A:Congenital hemangioma or Rapidly Involuting Congenital Hemangioma (RICH) is a similar benign tumor (birthmark) to infantile hemangioma, but it differs from infantile hemangioma in that it has a fully developed presentation at birth, with rapid involution and regression. Overall, congenital hemangioma is a rare entity. Recognizing these congenital birthmarks and differentiating them from other congenital lesions or tumors is very important to reduce unnecessary invasive diagnostic procedures (surgical biopsies or major surgical excision procedures) in these newborns, because most of these birthmarks involute rapidly. The appropriate diagnostic test is ultrasonography with Doppler and/or magnetic resonance imaging (MRI). The imaging features of these tumors (birthmarks) also greatly differ from more common types of infantile hemangioma, but may be confused with arteriovenous malformations (AVM). Various sized cystic vascular lesions with arteriovenous connections similar to high-flow lesions (AVM) are commonly seen on ultrasound examinations or MRI scans. Interpretation of these scans (US or MRI) by an experienced radiologist or interventional radiologist is important for accurate diagnosis. Some tumors may require tissue sampling (biopsy) for definite diagnosis. These lesions (birthmarks) usually rapidly involute (shrink), usually much faster than common hemangiomas. However, some patients may develop significant health problems (e.g., cardiac failure, bleeding due to arteriovenous shunting. Therefore, patients with these rare birthmarks need to be followed closely and appropriate therapeutic intervention should be implemented whenever needed. Embolization should be used if needed. Medical intervention (oral steroids) is similar to that of infantile hemangiomas.