title: Life-threatening hemorrhaging in neonatal ulcerated congenital hemangioma: two case reports.
abstract: OBJECTIVE
  Congenital hemangiomas (CHs) are rare benign vascular tumors that differ from common infantile hemangiomas in that they grow in utero and are fully developed at birth. While ulceration is a common, predominantly benign complication in infantile hemangioma, little is known about the prognosis of ulcerated CH. However, it has been observed that ulcerated CH may be complicated by life-threatening bleeding episodes.
  
  
  METHODS
  We report 2 cases of ulcerated rapidly involuting congenital hemangiomas (RICH) that were complicated by life-threatening bleeding episodes in the neonatal period. In both cases, the CHs were fed by high-flow vessels and the ensuing massive bleeding was due to superficial vessel wall erosion induced by the ulceration. Both patients were successfully treated with intravascular embolization; one patient underwent additional hemostatic surgery.
  
  
  CONCLUSIONS
  These 2 cases highlight the importance of closely monitoring children with ulcerated CH because of the risk of severe bleeding. Embolization is the treatment of choice in the case of severe bleeding, as the natural history of RICH is to spontaneously regress.
authors.affiliation: Department of Dermatology, Nantes University Hospital, Nantes, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Vildy
authors.affiliation: Department of Intensive Care of Neonatology, Nantes University Hospital, Nantes, France.
authors.forename: Julie
authors.initials: J
authors.lastname: Macher
authors.affiliation: Department of Dermatology, Brest University Hospital, Brest, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Abasq-Thomas
authors.affiliation: Department of Infantile Surgery, Brest University Hospital, Brest, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Le Rouzic-Dartoy
authors.affiliation: Department of Interventional Radiology and Dermatology, Necker Enfants Malades University Hospital, Paris, France.
authors.forename: Francis
authors.initials: F
authors.lastname: Brunelle
authors.affiliation: Department of Interventional Radiology and Dermatology, Necker Enfants Malades University Hospital, Paris, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Hamel-Teillac
authors.affiliation: Department of Vascular and Plastic Surgery, Nantes University Hospital, Nantes, France.
authors.forename: Franck
authors.initials: F
authors.lastname: Duteille
authors.affiliation: Department of Vascular and Plastic Surgery, Nantes University Hospital, Nantes, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Perret
authors.affiliation: Department of Vascular and Plastic Surgery, Nantes University Hospital, Nantes, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Perrot
authors.affiliation: Department of Histology, Nantes University Hospital, Nantes, France.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Cassagnau
authors.affiliation: Department of Intensive Care of Neonatology, Nantes University Hospital, Nantes, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Chauty-Frondas
authors.affiliation: Department of Dermatology, Nantes University Hospital, Nantes, France.
authors.forename: Helene
authors.initials: H
authors.lastname: Aubert
authors.affiliation: Department of Dermatology, Nantes University Hospital, Nantes, France.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Barbarot
mesh_terms: D004621:Embolization, Therapeutic / Q000379:methods; D005260:Female; D006391:Hemangioma / Q000150:complications* / Q000151:congenital; D006470:Hemorrhage / Q000209:etiology* / Q000628:therapy; D006488:Hemostasis, Surgical / Q000379:methods; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011379:Prognosis; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014456:Ulcer / Q000150:complications* / Q000209:etiology