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Zvizdic D, Bulja D, Sidran A, Skenderi F, Zvizdic Z, Vranic S. Isolated deep orbital hemangioma treated successfully with oral propranolol in a 2-month-old infant: Case report with literature review. Am J Ophthalmol Case Rep 2021; 22:101095. [PMID: 33981915 PMCID: PMC8082548 DOI: 10.1016/j.ajoc.2021.101095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 03/07/2021] [Accepted: 04/12/2021] [Indexed: 12/01/2022] Open
Abstract
Purpose Infantile hemangiomas (IH) are the most common benign vascular tumors of infancy. Ocular complications due to orbital IH include strabismal, deprivational, or anisometropic astigmatism, and visual loss secondary to amblyopia. Observations We report a case of a two-month-old female infant with a severe deep orbital IH. The diagnosis was established by clinical examination and magnetic resonance imaging (MRI). The patient was treated with oral propranolol for six months. Complete tumor regression was observed clinically and by MRI following the treatment. The patient showed no adverse effects or tumor recurrence at the 14-month follow-up. Conclusions and Importance Despite its benign nature, periorbital IH requires a rapid diagnosis and prompt treatment to prevent vision loss, particularly in infants. Our case confirms that oral propranolol may be regarded as a safe drug for periorbital IH with an excellent outcome.
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Affiliation(s)
- Denisa Zvizdic
- Eye Clinic, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Deniz Bulja
- Department of Radiology, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Amila Sidran
- Pediatric Clinic, University Clinic Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Faruk Skenderi
- Department of Pathology, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Zlatan Zvizdic
- Clinic of Pediatric Surgery, University Clinic Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Semir Vranic
- College of Medicine, QU Health, Qatar University, Doha, Qatar.,Biomedical and Pharmaceutical Research Unit, QU Health, Qatar University, Doha, Qatar
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Albanese G, Mohandas P, Wells L, Ravenscroft J, Srinivasan J, Thomas S, Taylor T, Tambe K. Orbital infantile haemangioma: radiological features and treatment - case series and literature review. Orbit 2018; 38:67-71. [PMID: 30040513 DOI: 10.1080/01676830.2018.1501397] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
AIM The aim of this study is to report a retrospective case series on orbital infantile haemangiomas (OIH). Radiological features and treatment with oral propranolol (OP) are illustrated along with an updated literature review. METHODS A retrospective chart review of six children, diagnosed with OIH from November 2015 to October 2016, was carried out. Only children with deep documented orbital involvement were included. All patients underwent magnetic resonance imaging (MRI) under general anaesthesia. OP was administered to the infants according to the Nottingham Children's Hospital guideline. As per the guideline, a preliminary paediatric assessment was performed and a 1 mg/kg test dose was administered, followed by definitive treatment at a dosage of 2 mg/kg in three divided doses. RESULTS Average age at presentation was within the first 3 weeks of life. T1 hypointensity, T2 hyperintensity, avid enhancement with contrast, and the presence of flow-voids appear a fixed pattern of OIH on MRI. Response to treatment was noticed within 4 weeks in all children, and two of them (33.3%) responded within the first 7 days. In two children (33.3%), the haemangioma became clinically undetectable by the seventh month of treatment, while the other four (66.6%) experienced an almost complete regression of the OIH by the last follow-up. No complications were found. CONCLUSIONS Our series strengthens the understanding that MRI is the preferred imaging modality in the investigation of OIH, showing vascular features, detailed orbital extension, and possible associated malformations. OP is the treatment of choice for OIH, and our study confirms its safety and effectiveness.
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Affiliation(s)
- Giorgio Albanese
- a Department of Ophthalmology , Queen's Medical Centre, Nottingham University Hospitals NHS Trust , Nottingham , United Kingdom
| | - Padma Mohandas
- b Department of Dermatology , Queen's Medical Centre, Nottingham University Hospitals NHS Trust , Nottingham , United Kingdom
| | - Louise Wells
- c Nottingham Children's Hospital , Queen's Medical Centre, Nottingham University Hospitals NHS Trust , Nottingham , United Kingdom
| | - Jane Ravenscroft
- b Department of Dermatology , Queen's Medical Centre, Nottingham University Hospitals NHS Trust , Nottingham , United Kingdom
| | - Jothsana Srinivasan
- c Nottingham Children's Hospital , Queen's Medical Centre, Nottingham University Hospitals NHS Trust , Nottingham , United Kingdom
| | - Shery Thomas
- a Department of Ophthalmology , Queen's Medical Centre, Nottingham University Hospitals NHS Trust , Nottingham , United Kingdom
| | - Timothy Taylor
- d Department of Imaging , Queen's Medical Centre, Nottingham University Hospitals NHS Trust , Nottingham , United Kingdom
| | - Katya Tambe
- a Department of Ophthalmology , Queen's Medical Centre, Nottingham University Hospitals NHS Trust , Nottingham , United Kingdom
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Shikata D, Nakagomi T, Yokoyama Y, Yamada Y, Nakajima M, Oyama T, Goto T. Debulking surgery for venous hemangioma arising from the epicardium: report of a case. World J Surg Oncol 2017; 15:81. [PMID: 28403869 PMCID: PMC5389096 DOI: 10.1186/s12957-017-1152-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 04/02/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiac hemangiomas are rare benign vascular tumors that can occur in any cardiac layer: endocardium, myocardium, or epicardium. Histologically, cardiac hemangiomas may be classified as capillary, cavernous, or arteriovenous; venous hemangiomas are extremely rare. CASE PRESENTATION A 46-year-old man reported experiencing precordial discomfort. Computed tomography revealed a massive tumor adjacent to the right ventricle. The right coronary artery was found to be located at the center of the tumor. Cardiovascular angiography showed that the artery was completely encased by the tumor without any obstruction and that the right ventricular lumen was compressed by the tumor. Surgical debulking of the tumor was performed under cardiopulmonary bypass, and the frozen section led to a diagnosis of benign hemangioma. The tumor was debulked as much as possible until the right coronary artery appeared. For decompression of the heart, the pericardium was left open to the thoracic cavity and unsutured. Histopathologic examination revealed a diagnosis of epicardial venous hemangioma. CONCLUSIONS Cardiac hemangioma should be included in the differential diagnosis of mediastinal tumor in reference to the location and flow of the coronary artery. Surgical resection, or at least tumor debulking, is required to confirm the diagnosis and prevent further complications and has a favorable clinical outcome.
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Affiliation(s)
- Daichi Shikata
- Department of General Thoracic Surgery, Yamanashi Central Hospital, Yamanashi, Japan
| | - Takahiro Nakagomi
- Department of General Thoracic Surgery, Yamanashi Central Hospital, Yamanashi, Japan
| | - Yujiro Yokoyama
- Department of Cardio-Thoracic Surgery, Yamanashi Central Hospital, Yamanashi, Japan
| | - Yukiko Yamada
- Department of Cardio-Thoracic Surgery, Yamanashi Central Hospital, Yamanashi, Japan
| | - Masato Nakajima
- Department of Cardio-Thoracic Surgery, Yamanashi Central Hospital, Yamanashi, Japan
| | - Toshio Oyama
- Department of Pathology, Yamanashi Central Hospital, Yamanashi, Japan
| | - Taichiro Goto
- Department of General Thoracic Surgery, Yamanashi Central Hospital, Yamanashi, Japan. .,Lung Cancer and Respiratory Disease Center, Yamanashi Central Hospital, Yamanashi, 400-8506, Japan.
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Sendrasoa FA, Ranaivo IM, Razanakoto NH, Andrianarison M, Ramarozatovo LS, Rapelanoro Rabenja F. Excellent response of infantile orbital hemangioma to propranolol. Int Med Case Rep J 2016; 9:369-371. [PMID: 27895515 PMCID: PMC5118031 DOI: 10.2147/imcrj.s122553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Infantile hemangiomas are the most common vascular neoplasm that present in infancy, with more than half affecting the head and neck region. Periocularly, hemangiomas may be complicated by visual loss through induction of strabismal, deprivational, or anisometropic astigmatism. We report a case of a 5-year-old girl who presented with orbital hemangioma with potential risk of visual loss who had excellent response to propranolol.
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Affiliation(s)
- Fandresena A Sendrasoa
- Department of Dermatology, University Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar
| | - Irina M Ranaivo
- Department of Dermatology, University Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar
| | - Naina H Razanakoto
- Department of Dermatology, University Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar
| | | | - Lala S Ramarozatovo
- Department of Dermatology, University Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar
| | - F Rapelanoro Rabenja
- Department of Dermatology, University Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar
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Tran AQ, Choi CJ, Wester ST. Beta Blockers in the Treatment of Periocular Infantile Hemangiomas: A Review. INTERNAL MEDICINE REVIEW (WASHINGTON, D.C. : ONLINE) 2016; 2:221. [PMID: 32318646 PMCID: PMC7172575 DOI: 10.18103/imr.v2i9.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Infantile hemangiomas (IH) are the most common benign tumor of infancy, and in the periocular region can be associated with permanent visual impairment from amblyopia. Previous treatment options included systemic and local corticosteroids, surgical excision, laser therapy, and in rare cases immunomodulatory therapy, many of which had variable outcomes with undesirable side effect profiles. Since their initial use for IH in 2008, beta blockers have become the mainstay of therapy for periocular IH due to their excellent clinical efficacy and tolerability. While the exact mechanism of action of beta blockers in IH has not been fully elucidated, both oral and topical therapy have demonstrated low rates of adverse events and improved outcomes in the management of periocular IH. This review summarizes the most recent studies on the clinical outcomes, management, and guidelines for the treatment of periocular IH with topical and oral beta blockers.
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Affiliation(s)
- Ann Q Tran
- University of Miami – Bascom Palmer Eye Institute, Department of Ophthalmology
| | - Catherine J Choi
- University of Miami – Bascom Palmer Eye Institute, Department of Ophthalmology
| | - Sara T Wester
- University of Miami – Bascom Palmer Eye Institute, Department of Ophthalmology
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Abstract
Oral propranolol is now established as the first-line treatment for infantile haemangiomas, and used in up to 20 % of all cases. Propranolol use in infants is most commonly instigated in a controlled environment to monitor for potential serious adverse events such as hypoglycaemia and hypotension. Two test doses are recommended, the first one of 300 μg/kg followed by 2-hourly monitoring. On the subsequent day, a further dose of 650 μg/kg is administered with the same monitoring. A dose of 2 mg/kg divided into three is started from the next day. Parents/carers need to be warned of common adverse effects, of which disturbed sleep is the commonest. Treatment is recommended for up to a year to avoid rebound growth and the need to restart the treatment.
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Affiliation(s)
- Robert H Taylor
- Eye Department, York Hospital, Wigginton Road, York, YO31 8HE, England.
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