Surgical Management of Pediatric Venous Malformations Misdiagnosed As Infantile Hemangiomas: A Report of Two Cases

TL;DR

Two children with venous malformations initially misdiagnosed as infantile hemangiomas underwent successful surgical removal after proper diagnosis.

Contribution

Highlights the importance of accurate diagnosis using MRI and ISSVA guidelines to avoid ineffective treatment and enable effective surgical management.

Findings

Propranolol treatment was ineffective for the two cases of venous malformations.

MRI features and ISSVA classification helped correctly identify the lesions as venous malformations.

Complete surgical excision provided good outcomes with no recurrence.

Abstract

Venous malformations (VMs) are low-flow vascular malformations that must be distinguished from vascular tumors such as infantile hemangioma (IH). Misclassification leads to inappropriate therapy and delayed definitive management.

We report two children with congenital, enlarging, compressible subcutaneous masses (inframammary and dorsal). Both had been labeled IH in infancy and received oral propranolol with no response. MRI showed lobulated subcutaneous lesions, T2 hyperintense and T1 iso-/hypointense, without arterial flow voids or invasion. Both underwent complete surgical excision; reconstruction used a split-thickness skin graft in case one and primary closure in case two. Histopathology demonstrated dilated, thin-walled venous channels lined by bland endothelium, confirming VM. Recovery was uneventful with satisfactory cosmetic outcomes and no early recurrence.

In compressible, bluish lesions present at birth and growing proportionally, the International Society for the Study of Vascular Anomalies (ISSVA) framework and MRI features should guide diagnosis. Propranolol is ineffective for VMs. For well-circumscribed subcutaneous lesions causing symptoms or psychosocial burden, complete excision is a safe and effective option.

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