Cavernous Hemangioma

The patient we see above has a large, protruding mass extending from the upper back that has dilated blood vessels, a mottled appearance and there are three more discrete vascular-looking papules on the right arm.  The fact that it is so large, and that the baby is clearly not paralyzed points away from a meningocele or extracutaneous neural tissue.  This is a typical, albeit dramatic example of a cavernous infantile hemangioma.

Although they are benign tumors of blood vessels, cavernous hemangiomas are particularly worrisome in that they can bleed, profusely at times, and because they can lead to high-output cardiac failure.  They nearly always involute on their own, but can still be life-threatening.  

For those hemangiomas such as this one, there are multiple options, including steroids and interferon, but the treatment of choice seems to be migrating toward beta blockers, particularly propranolol, although timolol is gaining favor recently.  The mechanism of action may be related to action on the feeding vessels, or cell death in the vascular channels, or both.