Perinatology.  2017 Dec;28(4):177-183. 10.14734/PN.2017.28.4.177.

Neonatal Diaphragmatic Hemangioma associated with Diffuse Neonatal Hemangiomatosis treated with Coil Embolization

Affiliations
  • 1Department of Pediatrics, Korea University College of Medicine, Seoul, Korea. hongys@korea.ac.kr

Abstract

Neonatal diaphragmatic hemangioma (NDH) with diffuse neonatal hemangiomatosis has rare incidence. Hydrops fetalis can be found on prenatal ultrasonography and pleural effusion, pericardial effusion, and ascites can be found on postnatal ultrasonography. NDH can be treated with medical, interventional and surgical methods. We report a rare case of NDH which was successfully treated by coil embolization. The patient presented with cardiac tamponade, respiratory distress and abdominal distension are observed after birth due to massive fluid production by diaphragmatic hemangioma. Two times of interventional coil-embolization has made the infant's symptoms and signs alleviated through decreasing massive fluid collected in pericardial, pleural and abdominal space.

Keyword

Hydrops fetalis; Hemangioma; Diaphragm; Cardiac tamponade; Ascites

MeSH Terms

Ascites
Cardiac Tamponade
Diaphragm
Embolization, Therapeutic*
Hemangioma*
Humans
Hydrops Fetalis
Incidence
Parturition
Pericardial Effusion
Pleural Effusion
Ultrasonography
Ultrasonography, Prenatal

Figure

  • Fig. 1 Radiograph showed a mass in the right lower hemithorax. Bilateral pleural effusion and ascites were observed.

  • Fig. 2 Chest computed tomography axial image (A), coronal image (B) showed 5×5×2 cm sized, lobulated, multiseptated enhancing mass between heart and diaphragm.

  • Fig. 3 (A) Thoracic aortography showed inferior vena cava interruption and hemagiomatous mass supplied by right internal mammary artery and both inferior phrenic arteries. (B) Coil embolization. Right internal mammary artery was embolized with Interlock coils (4 mm×8 cm, 3 mm×6 cm) (empty arrow). Left inferior phrenic artery was embolized with Tornado coil (3 mm×2 cm).

  • Fig. 4 Multiple purpuric to erythematous nodules and macules over the right cheek, right foot, posterior neck, and left preauricular region.

  • Fig. 5 Chest magnetic resonance imaging showed lobulating highly enhancing mass between heart and diaphragm on T2 weighted image, mildly decreased in size compared to previous chest computed tomography.

  • Fig. 6 Coil embolization. Previously embolized right internal mammary artery was embolized with two additional Tornado coils (3 mm×2 cm). Right (empty arrow) and left inferior phrenic artery were embolized with Tornado coils (right: 3 mm×2 cm and 4 mm×2 cm [3 coils], left: 3 mm×6 cm [2 coils]).


Reference

1). Mandal AK., Lee H., Salem F. Review of primary tumors of the diaphragm. J Natl Med Assoc. 1988. 80:214–7.
2). Olafsson G., Rausing A., Holen O. Primary tumors of the diaphragm. Chest. 1971. 59:568–70.
Article
3). Cacciaguerra S., Vasta G., Benedetto AG., Bagnara V., Guarnera S., Bartoloni G, et al. Neonatal diaphragmatic hemangioma. J Pediatr Surg. 2001. 36:E21.
Article
4). Wu L., Wang JM., Qiao ZW., Yan YL., Wang LS. Successful embolization and long-term follow-up of a rare neonatal diaphragmatic hemangioma. SAGE Open Med Case Rep. 2015. 3:2050313X15615471.
Article
5). Kaniklides C., Dimopoulos PA. Diaphragmatic haemangioma. A case report. Acta Radiol. 1999. 40:329–32.
6). Cambonie G., Saguintaah M., Masson F., Prodhomme O., Boulot P., Couture A, et al. Rapidly involuting congenital diaphragmatic hemangioma. Eur J Radiol Extra. 2009. 72:e125–8.
Article
7). Olsen L., Gustafsson G., Kreuger A., Pech P. Un unusual case of hemangioma of the left diaphragm in a child. Successful use of Lyodura S for repair of the diaphragmatic defect. Pediatr Surg Int. 1995. 10:259–60.
Article
8). George A., Mani V., Noufal A. Update on the classification of hemangioma. J Oral Maxillofac Pathol. 2014. 18(Suppl 1):S117–20.
Article
9). Matulich J., Wood G., Sugo E. Case of non-involuting congenital haemangioma. Australas J Dermatol. 2005. 46:165–8.
Article
10). Luu M., Frieden IJ. Haemangioma: clinical course, complications and management. Br J Dermatol. 2013. 169:20–30.
Article
11). Restrepo R., Palani R., Cervantes LF., Duarte AM., Amjad I., Altman NR. Hemangiomas revisited: the useful, the unusual and the new. Part 1: overview and clinical and imaging characteristics. Pediatr Radiol. 2011. 41:895–904.
12). Krol A., MacArthur CJ. Congenital hemangiomas: rapidly involuting and noninvoluting congenital hemangiomas. Arch Facial Plast Surg. 2005. 7:307–11.
13). Liang MG., Frieden IJ. Infantile and congenital hemangiomas. Semin Pediatr Surg. 2014. 23:162–7.
Article
14). Tsang FH., Lun KS., Cheng LC. Hemangioma of the diaphragm presenting with cardiac tamponade. J Card Surg. 2011. 26:620–3.
Article
15). Curros F., Brunelle F. Prenatal thoracoabdominal tumor mimicking pulmonary sequestration: a diagnosis dilemma. Eur Radiol. 2001. 11:167–70.
Article
16). Bellini C., Hennekam RC. Non-immune hydrops fetalis: a short review of etiology and pathophysiology. Am J Med Genet A. 2012. 158A:597–605.
Article
17). Ismail KM., Martin WL., Ghosh S., Whittle MJ., Kilby MD. Etiology and outcome of hydrops fetalis. J Matern Fetal Med. 2001. 10:175–81.
Article
18). Bellini C., Hennekam RC., Fulcheri E., Rutigliani M., Morcaldi G., Boccardo F, et al. Etiology of nonimmune hydrops fetalis: a systematic review. Am J Med Genet A. 2009. 149A:844–51.
Article
19). Ferrandiz L., Toledo-Pastrana T., Moreno-Ramirez D., Bardallo-Cruzado L., Perez-Bertolez S., Luna-Lagares S, et al. Diffuse neonatal hemangiomatosis with partial response to propranolol. Int J Dermatol. 2014. 53:e247–50.
Article
20). Rialon KL., Murillo R., Fevurly RD., Kulungowski AM., Zurakowski D., Liang M, et al. Impact of screening for hepatic hemangiomas in patients with multiple cutaneous infantile hemangiomas. Pediatr Dermatol. 2015. 32:808–12.
Article
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