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Table 1 Characteristics of benign, locally aggressive/borderline, and malignant vascular tumors

From: Vascular lesions of the head and neck: an update on classification and imaging review

Vascular TumorsPresentationImagingImportant Considerations
 Infantile HemangiomaPresent 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 HemangiomaUsually present in the first year of life.Intermediate T1 signal. High T2 signal.Differentiated from infantile hemangiomas based on clinical course.
 Tufted AngiomaDevelops within the first five years of life with red or violaceous plaques.Imaging rarely performed. 
 Spindle Cell HemangiomaPresent 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 GranulomaOccur secondary to prior insult such as trauma or burns.Isointense T1. Variable T2 signal. 
Present with bleeding.
Locally Aggressive/Borderline
 Kaposiform HemangioendotheliomaMost 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.
 HemangioendotheliomaPresents in adults as one or more slow growing nodules.Usually evident on physical exam.Distant metastasis rare.
 Papillary Intralymphatic AngioendotheliomaPrimary involves the skin and subcutaneous tissues.Isointense T1 signal.Distant metastasis rare.
Heterogeneously increased T2 signal. Variable enhancement.
Often demonstrates local aggressive invasion.
 AngiosarcomaCan 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. 
 Epithelioid HemangiomaOften 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.