A case of diaphragmatic infantile hemangioma

摘要

A 2825-g infant, identified to have right-sided pleural effusion by routine prenatal ultrasound, was born at 35-weeks gestation to a G1, PI mother by Cesarean section. After delivery, the neonate was sent to our medical center and presented with dyspnea. The oxygen saturation was 90%, respiratory rate was 70 breaths per min and the heart rate was 140 beats per min. Chest X-ray showed right-sided pleural effusion and mediastinal shift and the suggestion of an abnormal mass of the right diaphragm (Figure 1a). MDCT (Figure 1b) and MR (Figure 1c) imaging confirmed the presence of a multi-nodular, sessile lesion along the right diaphragm extending to the right cardiac border. The mass was gradually enhanced to a moderate extent demonstrating multiple septa inside, in concordance with the appearance of hemangioma. MR revealed that the right thoracic wall and the right-sided pericardium were also invaded. In reconstructed images of MDCT, two dilated vessels were detected coursing in front of the right thorax. One was the right internal mammary artery arising from carotid artery identified as the feeding artery by interventional angiography (Figure 2), and the other was the related vein merging into the superior vena cava. Initial management with propanolol did not alleviate the symptoms, and the pleural effusion increased gradually. Thereafter, interventional vascular embolization was accomplished, which was followed by an uneventful recovery.