By Gary M. White, MD
Multiple small hemangiomas in an infant with liver involvement. (Courtesy Michael O. Murphy, MD)
Multifocal infantile hemangiomas (MIF), formerly called neonatal hemangiomatosis, is the presence of more than five infantile hemangiomas in an infant.
Two types of hemangiomas have been identified:
The miliary type are smaller and more numerous and can manifest up to an older age (up to 27 months). Their presence (alone or in combination with classic) is more commonly associated with extracutaneous hemangiomas. In one review [PD 2016;33;621], 20.7% of infants with Miliary alone and 32.1% of those with both miliary and classic had hepatic hemangiomas, as opposed to only 5% with classic only. The average number of hemangiomas in that study was significantly higher in children with the Miliary type (23.4 ± 27.3) than in those with Classic type only (7.4 ± 2.8).
Complications of internal lesions (e.g. of the brain, eyes, spleen, lungs, intestine) include hemorrhage and obstruction of vital structures.
Ultrasound of the abdomen with special attention to the liver and spleen should be performed for patients with 5 or more cutaneous hemangiomas. It may be repeated every few months if the cutaneous lesions are proliferating.
Other possible studies depending upon the sites involved include an abdominal ultrasound, complete blood count, liver function tests, coagulations studies, urinalysis, echocardiography, stool guaiac, and central nervous system imaging. Of note, patients with diffuse infantile hepatic hemangiomas commonly have consumptive hypothyroidism.
Cutaneous hemangiomas usually resolve spontaneously. If treatment is needed, see infantile hemangioma. Referral to a specialist is in order for internal lesions.
New Zealand Healthboard
63 cutaneous hemangiomas with hemangioma of liver and kidneys. J Pediatr Hematol Oncol. 2009 Nov;31(11):858-60
JAAD November 2012 Volume 67, Issue 5, Pages 898–903
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