title: Impact of Screening for Hepatic Hemangiomas in Patients with Multiple Cutaneous Infantile Hemangiomas.
abstract: OBJECTIVE
  Hepatic hemangiomas are often found in association with multiple cutaneous infantile hemangiomas. Screening abdominal ultrasonography has been recommended for patients with five or more cutaneous lesions. We sought to determine whether hemangiomas found through screening had improved clinical outcomes.
  
  
  METHODS
  Patients entered into our hepatic hemangioma registry between 1995 and 2012 were reviewed.
  
  
  RESULTS
  Seventy-two patients with multiple cutaneous and hepatic hemangiomas were identified; 43 (60%) were detected through screening. The median age at diagnosis was 41 days for screened patients and 53 days for those not screened. Screening detected 40 (93%) multifocal and 3 (7%) diffuse hemangiomas, compared to 18 (62%) and 11 (38%), respectively, in the nonscreened group. Patients identified by screening had lower incidences of congestive heart failure and hypothyroidism and were less likely to receive treatment for their hemangiomas. The mortality rate in the children not screened was 28% (n = 8). None of the patients found by screening died (p < 0.001). Multivariate analysis of treated patients demonstrated that screening was a significant predictor of reduced mortality (p = 0.04).
  
  
  CONCLUSIONS
  Hepatic hemangiomas found through screening ultrasonography are less likely to develop serious clinical sequelae. Although the reasons for this may include detection of hemangiomas that are less likely to progress to symptomatic disease, it appears that it also allows for earlier intervention for more concerning (e.g. diffuse) subtypes. Screening may allow for closer surveillance and earlier treatment before life-threatening progression in a subset of infants with liver hemangiomas, preventing complications and reducing mortality.
authors.affiliation: Department of Surgery, Boston Children's Hospital, Boston, Massachusetts.|Vascular Anomalies Center, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Kristy L
authors.identifier: http://orcid.org/0000-0001-9369-5953
authors.initials: KL
authors.lastname: Rialon
authors.affiliation: Department of Surgery, Boston Children's Hospital, Boston, Massachusetts.|Vascular Anomalies Center, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Rudy
authors.initials: R
authors.lastname: Murillo
authors.affiliation: Department of Surgery, Boston Children's Hospital, Boston, Massachusetts.|Vascular Anomalies Center, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Rebecca D
authors.initials: RD
authors.lastname: Fevurly
authors.affiliation: Department of Surgery, Boston Children's Hospital, Boston, Massachusetts.|Vascular Anomalies Center, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Ann M
authors.initials: AM
authors.lastname: Kulungowski
authors.affiliation: Department of Surgery, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: David
authors.initials: D
authors.lastname: Zurakowski
authors.affiliation: Vascular Anomalies Center, Boston Children's Hospital, Boston, Massachusetts.|Department of Dermatology Program, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Marilyn
authors.initials: M
authors.lastname: Liang
authors.affiliation: Vascular Anomalies Center, Boston Children's Hospital, Boston, Massachusetts.|Department of Pathology, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Harry P W
authors.initials: HP
authors.lastname: Kozakewich
authors.affiliation: Vascular Anomalies Center, Boston Children's Hospital, Boston, Massachusetts.|Department of Radiology, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Ahmad I
authors.initials: AI
authors.lastname: Alomari
authors.affiliation: Department of Surgery, Boston Children's Hospital, Boston, Massachusetts.|Vascular Anomalies Center, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Fishman
mesh_terms: D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006391:Hemangioma / Q000175:diagnosis / Q000453:epidemiology*; D018324:Hemangioma, Capillary / Q000151:congenital / Q000175:diagnosis / Q000453:epidemiology*; D006776:Hospitals, Pediatric; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008113:Liver Neoplasms / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D008991:Monitoring, Physiologic; D015999:Multivariate Analysis; D015997:Neonatal Screening / Q000379:methods*; D011237:Predictive Value of Tests; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012878:Skin Neoplasms / Q000175:diagnosis / Q000453:epidemiology*; D015996:Survival Rate