Hemangiomas

Ever heard of a hemangioma?

If you have, you're one step ahead of me. I had no clue what one was until I had the twins.

The fast and ready definition...

A Hemangioma is a benign self-involuting tumor (swelling or growth) of endothelial cells, the cells that line blood vessels. It usually appears during the first weeks of life and resolves by age 10. In infancy it is the most common type of benign tumor. (Taken from Wikipedia)

When both the girls were a little under a month old we noticed small strawberry marks on them. Gabby had a flat red circle on her head, which I found when giving her a bath ( she has a lot of hair, so it was covered up pretty well). We noticed a flat red mark on Annabelle's right ear lobe and a pin prick sized red dot on her upper thigh.

We assumed they were just birthmarks (at this time their Pediatrician had not seen the marks). So, when we went to the Pediatrician for their one month check-up we showed the Dr. the marks on the babies.

HEMANGIOMA!

Hemangi-what?

She told us, they were common in preemies. That for whatever reason, the body made more blood-vessels than it needed in those areas where the red spots were. She said that the areas could continue to get bigger and could swell out. Eventually their bodies would realize the mistake and begin to correct it. She said the red areas would begin to turn gray, as the cells died, and eventually the hemangioma would be gone.

She warned us that depending on the size of the hemangioma, they may need surgery to tack up any saggy skin left behind once the hemangioma started to regress.

Great.

Anyways, she told us it would be as big as it was going to get probably around the 2-3 month mark.

All in all, we weren't too worried. Even as the marks on Gabby's head and Annabelle's ear grew and swelled, we weren't too worried, since down the line, it would correct itself.

Honestly, we weren't really shocked by the sizes. Gabby's is pretty well covered up by her hair, and while Annabelle's earlobe got pretty inflated, it just didn't seem too terribly drastic to us. We forgot how odd it looked until strangers would come up to us asking what was wrong?

You can see Annabelle's right ear here. This was take when we brought her home from the hospital. No red marks, no inflated earlobe, just a normal looking ear.

And this is my sweet girl at 6 months old, with her fully grown sized hemangioma on her ear lobe!

Pretty drastic huh?

So, those who read this blog, know Annabelle eventually had to get her hemangioma removed. Gabby still has the one on her head, and it's already starting to turn gray! Yay!

The rest of this post, I want to focus on the complications that arose with Annabelle's Hemangioma....

Here she is a few days home from the hospital, with a normal looking ear.

This picture was taken around the 2 month mark, you can see on her right ear the flat red beginnings of the hemangioma

This was taken at Halloween (Annabelle on the left). She was almost 3 months, this is when her lobe began swelling.

Again, if you look closely you can see the red on her right ear.

This was her, a little over 4 months old, you can get an idea of how inflated the hemangioma has become.

Another view (Annabelle is on the right). It was around 4 months when we noticed that her ear was beginning to scab. At her 4 month checkup her Pediatrician referred us to a Dermatologist, she felt like it was scabbing because when Annabelle would be laying on her back and turn her head, the hemangioma was so large it was rubbing against the floor or her mattress when she slept and getting irritated.

So, off to the Dermatologist.

The Derm. informed us that it was not a scab, but the hemangioma had become ulcerated.

This is not good. When this happens, the hemangioma becomes painful. She also felt like it had become infected as well.

She recommended some topical antibiotics and did a culture of her ear. She also recomended a steroid injection directly in to the hemangioma. She said injection would stimulate the hemangioma to deflate. The inflated portion of her lobe would go back to normal size but the red color would remain until her body 'healed' it. She also said we may need to consult a plastic surgeon because her lobe would have saggy skin.

We felt like the injection was a good idea, it would speed up the healing process, and since the hemangioma had become painful, we wanted it to be gone.

The injection was awful!

Poor Annabelle was in so much pain, and the whole situation was just plain traumatic.

to top it off, it didn't even work.

Before the trip to the dermatologist, we had been having feeding issues with Annabelle. She all of a sudden wouldn't eat. It was getting so frustrating, and the little bit of formula she would take, she'd throw back up. The week of the injection things kept getting worse. Then the Dermatologist called to let us know her ear culture came back positive for staph infection!

Yuck!

She immediately put Annabelle on oral antibiotics, which seemed to make the baby a new kid. She was eating, and doing great, once the infection cleared up. The Dermatologist felt, that since the hemangioma had become ulcerated and since it did not respond to the steroid injection at all, that it would probably continue to get infected and that it needed to be removed.

Off to the plastic surgeon.

Dr. Isaac Wornom performed Annabelle's surgery, and I can't say enough good things about this man.

He explained that in most cases of hemangioma's they don't do anything. They only want to remove them when they interfere with the development of a child. For instance, he had a case where a child had a large hemangioma on their eyelid and it was making it impossible for the child to open their eye!

He said in our situtation he wouldn't even bother removing the hemangioma because of it's location on her body, BUT since the instance of her infection, he felt like it needed to come off.

We were relieved. We wanted this thing out of our lives.

Basically, the way the procedure went, was he would completely cut out the inflated red part of her ear. He would cut it out like a wedge out of a piece of pie. Annabelle would still have the top of her ear and the bottom part of her lobe where the hemangioma was not present. So basically the middle part of her ear would be cut out. He would then attach the two ends.

Her ear would be much smaller than her other ear, but he said it shouldn't be deformed, and it would definitely still look like an ear.

So this was her, the morning of March 7, 2011 (surgery day)

And this was her the next day with her bandages, a happy, smiley girl :)

As I said, there are not enough good things I an say about Dr. Wornom. He did an AMAZING job. Her ear is smaller than her other ear, but honestly if you didn't know that, you wouldn't notice the size difference at all.

Here she is in the front post surgery. Normal looking ear!

I wanted to do this post, because if you are anything like me, when you're faced with something...you google it.

I knew nothing about hemangioma's until I had children who had them, so if you find yourself in my boat, hopefully this post helps. There can be complications involved as with Annabelle, but there can also be absolutely no problems at all, as with Gabby.

You can learn more about Hemangiomas, causes, and treatments here, here, and here. Often times children who have more than two hemangioma's are at risk for having internal hemangioma's as well. The Vascular Birthmarks Foundation has information, here.

For now though, cheers to happy girls :)