How to distinguish subcutaneous infantile hemangiomas from vascular malformations?

Subcutaneous hemangiomas in infants and young children are difficult to diagnose differently from congenital vascular malformations because they do not invade the skin and do not appear as bright strawberry red unlike hemangiomas on the skin surface, which only appear as localized slightly bluish soft tissue masses (as shown in the picture, in front of the ear). One is that hemangiomas are usually invisible at birth and increase rapidly after birth, whereas vascular malformations are present at birth and grow slowly. Secondly, ultrasound examination of hemangioma suggests abundant blood flow and fast blood flow, while venous vascular malformation generally has slow blood flow unless accompanied by arteriovenous malformation, which is mostly accompanied by vascular murmur, tremor and other signs and ultrasound examination is also very easy to make a judgment. If it is a hemangioma, there are usually several stages of rapid proliferation, stabilization and regression. Therefore, if the proliferation is not particularly fast and the location is not important, it can be simply observed without any treatment. If the growth is rapid, or located in a more important location, local hormone injections may be considered for treatment. Trimethoprim injection, 3 to 5 mg/kg/time. Once every 6-8 weeks. If local injections are not feasible, oral hormone therapy with prednisolone (2 to 3 mg/kg/day) is indicated. It is important to note that hormone therapy has some side effects, for example: attenuated vaccinations can be affected by hormones, and there are also some effects on the child’s appetite and mental status that need to be considered.