From: Vascular lesions of the head and neck: an update on classification and imaging review
Vascular Tumors | Presentation | Imaging | Important Considerations |
---|---|---|---|
Benign | |||
 Infantile Hemangioma | Present at birth. | Prominent serpiginous feeding vessel. | Delineate depth of lesion. |
Most commonly diagnosed in the first year of life. Rapid growth followed by slower growth and involution phases. | Iso- to intermediate T1 signal. | If lesion crosses multiple layers consider Kaposiform hemangioendothelioma. | |
 | Hyperintense T2 signal. Increased T1 signal due to fibrofatty infiltration in the involuting phase and decreased contrast enhancement. |  | |
 Congenital Hemangioma | Usually present in the first year of life. | Intermediate T1 signal. High T2 signal. | Differentiated from infantile hemangiomas based on clinical course. |
 Tufted Angioma | Develops within the first five years of life with red or violaceous plaques. | Imaging rarely performed. |  |
 Spindle Cell Hemangioma | Present as red or brown nodules. | Low T1 signal. High T2 signal lobulations. | Associated with Malfucci syndrome and Kaposiform hemangioendothelioma. |
May see associated lymphedema. | Often with phleboliths due to abnormal venous vasculature. | ||
 Pyogenic Granuloma | Occur secondary to prior insult such as trauma or burns. | Isointense T1. Variable T2 signal. |  |
Present with bleeding. | |||
Locally Aggressive/Borderline | |||
 Kaposiform Hemangioendothelioma | Most common aggressive tumor. | Predominantly hyperintense T2 signal with aggressive features (ill defined margins, involvement of multiple tissue planes, stranding of the subcutaneous fat, and hemosiderin deposition due to prior hemorrhage). |  |
Associated with thrombocytopenia and pain. | May involve adjacent bone. | ||
 Hemangioendothelioma | Presents in adults as one or more slow growing nodules. | Usually evident on physical exam. | Distant metastasis rare. |
 Papillary Intralymphatic Angioendothelioma | Primary involves the skin and subcutaneous tissues. | Isointense T1 signal. | Distant metastasis rare. |
Heterogeneously increased T2 signal. Variable enhancement. | |||
Often demonstrates local aggressive invasion. | |||
Malignant | |||
 Angiosarcoma | Can occur at any age, mainly 7th and 8th decades of life. | Intermediate T1 signal intensity. High T2 heterogeneity. | Can metastasis to lung and bone via hematogenous spread. |
Most occur in the head and neck, particularly the scalp. | Avid, heterogeneous enhancement. Flow voids or high-flow serpentine loss of signal on T1 and T2 imaging in a soft tissue mass is characteristic. | ||
Can occur secondary to chronic lymphedema and radiation. | Â | ||
 Epithelioid Hemangioma | Often incidental. | Can present as well marginated lucent lesions when involving osseous structures on radiography. Osseous lesions demonstrate T1 signal hyperintense to muscle. Heterogeneous high T2. | Potential for metastasis depending on grade. |
Typically presents between 30-50 years of age. |