【Definition】Hemangioma is a tumor or tumor-like disease with abnormal proliferation of vascular endothelial cells. It is generally divided into three types according to the location, superficial hemangioma, deep hemangioma and mixed hemangioma. Etiology】For the pathogenesis of hemangioma, it is usually believed that it comes from the abnormal proliferation of endothelial cells of endothelial progenitor cells that mutate during angiogenesis and angiogenesis. The clinical manifestations of hemangioma are complex and varied. First, in terms of the site of onset, it can develop in the skin or mucosa, or be located in deep tissue, or invade the skin, mucosa and deep tissue at the same time; the lesion can be single or multiple; it can be limited or diffuse. Second, in terms of time of onset, generally speaking, hemangiomas appear 1-2 weeks after birth. Most hemangiomas do not have lesions at birth, but about 30% of them can be found at birth. Hemangiomas that occur on the body surface generally present as bright red with high skin temperature. Ultrasound: It shows abnormal echogenicity in soft tissue with rich blood flow signal. CT: The lesion has smooth edges and appears as a solid mass with uniform density, and significant enhancement is seen in the arterial phase of the enhanced scan. MRI: The hemangioma is a high-flow solid occupancy with isosignal T1WI and high signal T2WI. The lesion is enhanced after injection of enhancer and a punctate flow-space effect is seen in the lesion. If thrombus is formed within the hemangioma, a signal non-enhanced area may appear within the hemangioma tissue; in late receding or receding hemangioma, the signal is increased in T1WI due to the presence of a large amount of replacement adipose tissue. Differential diagnosis 1.Venous malformation: When hemangioma is deep in the subcutis, it needs to be distinguished from venous malformation, which is usually found about 1 week after birth, grows significantly at full term, and usually can subside by itself after 1 year of age, while venous malformation usually exists at birth, has no obvious proliferation period, grows slowly, and cannot subside by itself. MRI can be performed for further differentiation. In addition, the venous malformation is positive in the postural test. 2.Lymphangioleioma: Sometimes deep hemangioma needs to be distinguished from lymphangioleioma, and the latter can be easily distinguished as no hemangioleioma signal can be found by ultrasound examination. Treatment】 1. Anti-inflammatory treatment: If the hemangioma breaks down and becomes infected, anti-infection treatment is needed, usually using second-generation cephalosporins and broad-spectrum antibiotics, as well as symptomatic treatment with Bactrim, Androflux, and Rehabin. 2. At present, the main treatment methods for hemangioma are drug therapy, laser therapy, isotope therapy, surgical resection and interventional therapy. 1.Drug therapy is applicable to systemic multiple hemangiomas, proliferative hemangiomas and hemangiomas involving important organs or life-threatening. The most commonly used drugs in clinical treatment of hemangioma are hormones and interferon. Oral corticosteroids have been used to treat hemangiomas for more than 30 years. Prednisone and prednisolone are often used as first-line agents, but they are effective only for proliferative hemangiomas and not for those in the degenerative phase; therefore, hormonal therapy is indicated for use in the first year of life. Later in the first year, hemangioma proliferation slows down and the efficacy of hormones decreases significantly. In conclusion, hormones should be used in sufficiently large doses as well as for a longer treatment period. The following treatment regimen is recommended: ① Prednisone or prednisolone at a dose of 3-5 mg/kg every other day, morning dose. ②Give appropriate amount of ranitidine etc. if necessary to prevent gastritis and gastroesophageal reflux. ③If the drug is ineffective for 2 weeks, treatment should be discontinued. If it is effective and the lesion decreases or stops growing, the application of adequate dose should be continued for at least 2-3 weeks. ④After 8-10 weeks thereafter, the drug should be tapered, either by reducing the dose by 1/2 in week 9, 10 mg per dose in week 10, 5 mg per dose in week 11, and discontinued in week 12, and repeated at 4-6 week intervals if 2-3 courses of therapy are needed. ⑤ If rebound (lesion continues to increase in size) occurs during or after dose reduction, adjust to a higher dose and start dose reduction after 1 week of maintenance. ⑥If rebound occurs again, the dose should be increased and continued for 2 weeks, followed by a gradual dose reduction. Interferon α-2а is suitable for the treatment of proliferative, life-threatening severe infantile hemangioma and Kasabach-Merritt syndrome (KMS), and is administered by subcutaneous injection once a day for 7-10 months with an efficiency of 80-90%. Intra-lesion injection of interferon alpha is suitable for the treatment of severe hemangioma, the method is once a day for the first week, each time 1 million to 3 million IU/m2 body surface area, followed by once a week, the average course of treatment is 8 weeks. The advantages are short treatment course, few complications, low treatment cost, and easy acceptance by patients. In 2008, Léauté-Labrèze et al. at the Children’s Hospital of Bordeaux, France, reported that they had unexpectedly found shrinkage of hemangiomas in a child with cardiomyopathy with severe hemangiomas and in another child with increased cardiac output with hemangiomas treated with propranolol. With the consent of the parents, they administered propranolol to 9 other children with maxillofacial hemangioma, and all of them showed a lightening of the hemangioma color and varying degrees of reduction in size 24 h after administration of the drug. Starting from October 2008, Prof. Qin Zhongping and Prof. Zheng Jiawei conducted a prospective study on the treatment of infantile hemangioma with low-dose propranolol and found that oral low-dose propranolol (1.0-1.5 mg/kg, once daily in a single dose) has good recent efficacy and mild adverse effects in the treatment of infantile hemangioma, which can replace the traditional prednisone regimen as the first-line treatment for infantile hemangioma. It is considered to replace the traditional prednisone regimen as the first-line treatment for infantile hemangioma. Professor Buckmiller of Arkansas Children’s Hospital, USA, believes that propranolol is an effective treatment for both proliferative and regressive hemangiomas in infants and children, and that the use of propranolol is a revolutionary change in the treatment of hemangiomas, and that it is safe and effective in most patients at therapeutic doses with minimal and manageable side effects. Professor Lawley of the Department of Dermatology, Emory University School of Medicine, Atlanta, USA, also reported 2 cases of hemangioma patients who were successfully treated with propranolol, in short, the drug is worthy of further clinical promotion. 2.Laser treatment The principle of laser treatment for hemangioma is to irradiate in smaller doses, with the aim of inducing the hemangioma to shrink and subside, rather than striving to eliminate the lesions at once, so as to avoid the formation of postoperative scar as much as possible. Patients with hemangioma lesions less than 5 mm in depth can obtain satisfactory results. For lesions deeper than 5mm, single laser treatment often has limited efficacy and needs to be combined with other treatment methods. 3.Isotope therapy Isotope therapy, i.e. radionuclide therapy, is commonly used for 90Sr dressing. Radionuclide therapy for superficial early hemangioma is effective, but it has the possibility of causing skin atrophy, contracture, pigmentation, pigment loss or alopecia, etc. The choice of this treatment method should be decided according to the site and size of the lesion. Surgical excision Surgical excision of hemangioma is technically difficult and is seldom performed at present, but surgery can be used to repair residual lesions, scar, hypertrophy or pigmentation when necessary. 5.Interventional treatment Commonly used interventional treatment methods include image guided percutaneous sclerosis and transcatheter atherosclerotic embolization. The former is to inject drugs (such as pinyamycin, dexamethasone, etc.) directly into the tumor through the local puncture route; the latter is to inject drugs into the tumor through the catheter arterial route and further embolization treatment when necessary. Interventional treatment is effective, less invasive, less costly and repeatable, and is increasingly used in clinical practice. Complications and treatment】 1.Tumor swelling: After interventional sclerosis, the tumor will be swollen, no uncomfortable reaction can be observed, if the swelling of the tumor causes unbearable pain, pain relief and symptomatic treatment should be given; if the swelling obviously compresses the trachea, hormone should be applied to reduce local edema. 2.Rupture of the tumor: In a few cases, the surface of the tumor ruptured after the intervention, and symptomatic anti-inflammatory treatment of Bactrim, Androflux and Rehabin is needed. 3, fever, diarrhea and other drug reactions: some children have side effects of Pingyangmycin after surgery, manifested as fever or diarrhea, which can be treated symptomatically. Admission criteria】 1. Outpatient diagnosis of hemangioma and the need for oral medication or interventional treatment; 2. Patients in good general condition, no chills, fever, no cough, runny nose and other symptoms of upper sensation. Criteria for consultation】 If the hemangioma is located in the eyelid or maxillofacial area and the family requires surgical removal, ophthalmology or dentistry can be consulted to consider the feasibility. Criteria for transfer to ICU】 Children with huge hemangioma in the neck compressing the trachea and requiring tracheal intubation for mechanical ventilation; children with unstable vital signs after intervention. Discharge criteria】 1. The patient is in good general condition, resumed normal diet, no nausea and vomiting. 2. Body temperature ≤ 37.5℃ on the day of discharge. 3.The child has no obvious pain, crying and restlessness. 4.No obvious swelling and blistering of the lesion and surrounding tissues, and no tendency of skin breakdown and necrosis. 5.No blood or ooze from the puncture site of the lesion. 6.No other complications that require hospitalization. Follow-up guidance】 1.General oral medication or interventional treatment, need 2 weeks after the outpatient review; 2.If the postoperative tumor rupture should be promptly returned to the hospital for consultation.