Isolated deep orbital hemangioma treated successfully with oral propranolol in a 2-month-old infant: Case report with literature review (original) (raw)
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Excellent response of infantile orbital hemangioma to propranolol
International Medical Case Reports Journal, 2016
Infantile hemangiomas are the most common vascular neoplasm that present in infancy, with more than half affecting the head and neck region. Periocularly, hemangiomas may be complicated by visual loss through induction of strabismal, deprivational, or anisometropic astigmatism. We report a case of a 5-year-old girl who presented with orbital hemangioma with potential risk of visual loss who had excellent response to propranolol.
Propranolol in the treatment of an extensive facial and orbital infantile hemangioma: case report
An infantile hemangioma, a common benign vascular tumor of infancy, can cause significant visual function impairment and/or relevant disfigurement. We report the successful outcome with oral propranolol treatment, with no adverse events related to the treatment, in a 2-month-old boy who presented with a complicated extensive infantile hemangioma of the right hemiface with deep intraorbital involvement, extending to the middle cranial fossa and pterygopalatine fossa.
Journal of the Royal Medical Services, 2014
Objectives: To evaluate the effect of oral propranolol in the treatment of infantile peri-orbital and/ or orbital capillary hemangioma. Methods: We conducted a prospective study at Prince Rashid Bin Al Hassan military hospital between 5 th of August 2012 and 29 th of January 2013. Eleven patients with peri-orbital and/or orbital capillary hemangiomas were included in this study. All patients underwent complete ophthalmic examination. Capillary hemangiomas were assessed, reporting their size, location, extension, and effect on the surrounding structures. Follow up duration ranged from two to six months. Results: The age of patients with peri-orbital and/ or orbital capillary hemangiomas ranged from three to 17 months with a mean of 7 ± 4.92 months. Male: female ratio was 1: 1.75. The upper eyelid was involved in seven (64%) cases, all of them had ptosis, three (43%) had dystopia, one (14%) had imbrication, and one (14%) had squint. The lower eyelid was involved in two (18%) cases; one of them was associated with lower lip capillary hemangioma. Orbital involvement was seen in eight (73%) cases, six (75%) of them were associated with upper eyelid involvement and two (25%) with lower eyelid involvement. Concurrent extra-ocular localization of hemangiomas was present in five (45%) cases (one in lip, one in tongue, 2 in forehead, and one in cheek). Duration of treatment ranged between one and 30 weeks with an average of 14.2 ± 11.4 SD weeks. The dose of propranolol ranged between 1-2 mg/kg with an average of 1.2 mg/kg and only one patient with upper eyelid and forehead extension needed 4 mg/kg. The color blanched in all patients after one week. The capillary hemangioma decreased in size after one week of treatment in two (18%) patients, and in all of them after one month. Complete regression of the hemangioma was seen in two (18%) cases one after two months and the other after 4 months of treatment. Five (45%) cases had astigmatism before the start of treatment (mean ±SD, 0.9 ± 0.379 D) diopters and improved to mean ±SD, 0.56 ± 0.586 D. Conclusion: Oral propranol can be used as a modality for therapy of infantile capillary hemangioma.
Middle East African Journal of Ophthalmology, 2011
Purpose: To investigate the efficacy and safety of oral propranolol in the management of periorbital infantile hemangioma in four subjects. Materials and Methods: Consecutive patients who presented with periorbital capillary hemangioma with vision-threatening lesions were prospectively enrolled in this study between January 2009 and October 2010. All subjects underwent treatment with 2 mg/kg/ day oral propranolol. All subjects underwent ocular, systemic, and radiologic evaluations before treatment and at periodic intervals after starting therapy. Side effects from therapy were also evaluated. Results: Four subjects, between 3 months and 19 months of age, with periorbital hemangioma were enrolled in this study. Two subjects had been previously treated with oral corticosteroids with unsatisfactory response. All subjects had severe ptosis, with the potential for deprivation amblyopia. Three subjects had orbital involvement. After hospital admission, oral propranolol was initiated in all subjects under monitoring by a pediatric cardiologist. Subsequent therapy was performed with periodic outpatient monitoring. All subjects had excellent response to treatment, with regression of periorbital and orbital hemangioma. There were no side effects from therapy. Conclusions: Oral propranolol for periorbital hemangioma was effective in all the four subjects. Oral propranolol may be appropriate for patients who are nonresponsive to intralesional or systemic steroids. In patients with significant orbital involvement and lesions causing visionthreatening complications, oral propranolol can be the primary therapy.
Efficacy and safety of propranolol as first-line treatment for infantile hemangiomas
European Journal of Pediatrics, 2010
Beta-blockers are a highly promising treatment modality for complicated infantile hemangiomas (IH). However, data on propranolol as first-line treatment, objective outcome measures and impact on hemodynamics in young infants is limited. We retrospectively evaluated a homogenous group of infants with proliferating complicated IH treated with propranolol (2 mg/kg/day). Outcome was assessed by blinded evaluation of clinical photographs by visual analogue scale (VAS), ultrasound examination and ophthalmological review (if appropriate). Tolerance and hemodynamic variables were recorded over time, including a 2-day in-patient observation at the initiation of therapy. Twenty-five infants (median age 3.6 (1.5-9.1) months) were included in the study. The median follow-up-time was 14 (9-20) months and 14 patients completed treatment at a median age of 14.3 (11.4-22.1) months, after a duration of 10.5 (7.5-16) months. In all patients, there was significant fading of colour (with a VAS of −9 (−6 to −9) after 7 months) and significant decrease in size of the IH (with a VAS of −8 (−3 to −10) after 7 months). Median thickness of the lesions assessed by ultrasound at baseline and after 1 month was 14 (7-28) mm and 10 (5-23) mm, respectively (p<0.01). In children with periocular involvement, astigmatism and amblyopia resolved rapidly within 8 weeks. The overall tolerance of propranolol was good, and no relevant hemodynamic changes were noted. Conclusion: Our report supports the excellent effect and good tolerance of this novel therapy, and we propose the use of propranolol as first-line treatment for IH.
World journal of plastic surgery, 2015
A 29 days old Pakistani female infant was presented to our outpatient department with two weeks history of a rapidly progressing large size facial hemangioma involving most of the right cheek and right eyelids. The infant was unable to open the right eye. There was also a small hemangioma on the right second toe. Additionally, three similar lesions were found on the right side of the palate and adjoining buccogingival surfaces. The parents were particularly concerned about the explosive progression of the lesions, recurrent bleeding episodes from ulcerated areas of the cheek lesion and complete occlusion of the right eye. Following four weeks therapy with propranolol in a dose of 2 mg/kg/day, the hemangiomas rapidly regressed, the bleeding episodes ceased and the infant started opening the eye.
Successful propranolol treatment of a large size infantile hemangioma of the face causing recurrent bleeding and visual field disruption. World J Plast Surg. 2015 Jan;4(1):79-83. [PubMed] PMID: 25606481 : PMCID:PMC4298869, 2015
A 29 days old Pakistani female infant was presented to our outpatient department with two weeks history of a rapidly progressing large size facial hemangioma involving most of the right cheek and right eyelids. The infant was unable to open the right eye. There was also a small hemangioma on the right second toe. Additionally, three similar lesions were found on the right side of the palate and adjoining buccogingival surfaces. The parents were particularly concerned about the explosive progression of the lesions, recurrent bleeding episodes from ulcerated areas of the cheek lesion and complete occlusion of the right eye. Following four weeks therapy with propranolol in a dose of 2 mg/kg/day, the hemangiomas rapidly regressed, the bleeding episodes ceased and the infant started opening the eye.
Efficacy of propranolol in severe segmental infantile hemangioma of the face
Our Dermatology Online
Infantile hemangioma (IH) is the most common benign vascular tumor of childhood. Most of IHs regress spontaneously, yet some require a more rapid intervention. Herein, we report the case of a two-month-old female who was brought in for consultation by the mother with a voluminous segmental IH of the face in respiratory distress. The infant was hospitalized, after taking advice from other specialists and performing a pre-treatment check-up, the patient was administered oral propranolol. Respiration returned to normal after several hours. The evolution was marked by the regression of the hemangioma and positive drug tolerance. Our observation shows the value of early diagnosis and the need for the rapid management of severe segmental IH of the face treated with oral propranolol. Apart from the efficacy of propranolol in the treatment of IH, we report the difficulties due to the unavailability of the adapted syrup form for infants in Guinea.