Vascular Anomalies in Children
The first thing that matters is the name. A haemangioma is a tumour that appears after birth, grows, and then shrinks on its own over years. A malformation is present from birth, grows steadily with the child, and never involutes — so it will not be outgrown, and 'wait and see' is not a plan for it. Telling them apart on examination and MRI decides everything that follows. Malformations are treated from the inside: a needle or catheter placed under imaging delivers a sclerosant or embolic agent into the lesion itself, without cutting through healthy tissue to reach it.
Dr. Mohamed El Ghobashy · Consultant Interventional Radiologist
What it treats
- •Venous malformations causing pain, swelling, or hard tender lumps from clotting within them
- •Lymphatic malformations, both the large-cyst and small-cyst types, including those that swell abruptly with infection
- •Arteriovenous malformations causing pain, bleeding, ulceration or an enlarging pulsating mass
- •Infantile haemangiomas that ulcerate, bleed or threaten a function such as vision or feeding, when medical treatment has not been enough
- •Lesions pressing on the airway, orbit, or a limb, or distorting growth
- •Lesions that have recurred after surgery or after previous injections elsewhere
Who is a candidate?
- Children whose lesion has been characterised on ultrasound and MRI — imaging, not appearance alone, decides the type and the treatment
- Children with symptoms: pain, bleeding, swelling, restricted movement, or pressure on a nearby structure
- Children referred through paediatric surgery, dermatology, ENT or the vascular anomalies team
- Small, painless lesions in a harmless location are often best left alone and simply watched
- Treatment is planned as a series of sessions from the outset, not as a single operation
How the procedure works
- 1
Characterisation
Ultrasound with Doppler and, in most cases, MRI define whether the lesion is venous, lymphatic or arteriovenous, how far it extends, and what lies next to it. The plan and the likely number of sessions come from this, not from how the lesion looks on the surface.
- 2
Anaesthesia
Sclerotherapy is done under general anaesthetic. The airway is assessed carefully beforehand when the lesion is in the neck, floor of mouth or face, because these can swell after treatment.
- 3
Direct puncture or catheter
For venous and lymphatic lesions a fine needle is placed directly into the lesion under ultrasound, and contrast confirms the needle is inside it and shows where the fluid drains. For arteriovenous malformations a catheter is navigated to the feeding vessels instead.
- 4
Sclerosant or embolic agent
A sclerosant is injected to scar the abnormal channels closed, chosen for the lesion type and site, or an embolic agent is delivered into the nidus of an arteriovenous malformation. The volume is calculated by the child's weight.
- 5
Planned repeat
The lesion is reassessed clinically and on MRI, and the next session is scheduled — typically six to twelve weeks later. Most children need several sessions.
Recovery
Expect the lesion to swell and become firm and sore for several days after each session — that is the treatment working, not a complication, and it settles over one to two weeks with simple pain relief. Children are usually observed overnight, and longer when the lesion is near the airway. Improvement is judged across the whole series rather than after one session: pain, swelling and bleeding usually improve first, and size follows. Venous and lymphatic malformations are controlled rather than cured, and a proportion re-expand over years and need a further session — which is expected, and is why follow-up continues.
Discuss this procedure
Private consultations and procedures are at Andalusia Hospitals, Maadi. Kasr Al-Ainy is Dr. El Ghobashy's academic post at Cairo University and does not take private cases.
Frequently asked questions
How many sessions will my child need?
Most children need between two and five, spaced six to twelve weeks apart, and large or diffuse lesions can need more. An honest estimate is given after the MRI, and it is reviewed as the lesion responds. Anyone promising a single definitive session for a malformation is describing a different condition.
Is this a birthmark that will go away on its own?
That depends entirely on which lesion it is, which is why imaging matters. Infantile haemangiomas do shrink on their own over years and many need no treatment at all. Vascular malformations do not — they were present at birth and grow with the child, so they are treated when they cause symptoms rather than waited out.
Will it leave a scar?
Sclerotherapy is delivered through a needle, so there is no surgical incision and no scar of the kind surgery leaves. Skin overlying a treated lesion can change in colour or texture, and lesions involving the skin itself carry a small risk of blistering or ulceration, which is discussed beforehand.
Why not just remove it surgically?
Sometimes surgery is the better answer, and it is discussed. But malformations infiltrate between normal muscle, nerve and vessel rather than sitting in a capsule, so removing all of one often means removing healthy tissue too, and incomplete removal is followed by regrowth. Sclerotherapy treats the lesion from within and leaves the surgical option open.
Other procedures
This page is general information, not medical advice for an individual. Whether a procedure suits you depends on your imaging, your history and an in-person assessment.