Ultrasonography Findings of Rare Form Deep Vulvar Hemangioma: A Case Report

Andrew Theo William Chris Purmata; Angling Febriani Ariqoh Ubaid; Emy Noviana Sandy; Ronald Pratama Adiwinoto

doi:10.26911/theijmed.2025.10.4.839

Authors

Andrew Theo William Chris Purmata Pondok Tjandra Mother & Child Hospital
https://orcid.org/0009-0008-9896-7522
Angling Febriani Ariqoh Ubaid Primasatya Husada Citra Hospital
https://orcid.org/0009-0009-7311-1645
Emy Noviana Sandy Labuha General Hospital
https://orcid.org/0009-0007-0307-4274
Ronald Pratama Adiwinoto 3) Department of Community Medicine, Faculty of Medicine, Hang Tuah University, Surabaya, East Java
https://orcid.org/0000-0002-2112-610X

DOI:

https://doi.org/10.26911/theijmed.2025.10.4.839

Abstract

Background: Hemangiomas are the most common vascular tumors in infants and children, they typically appear after birth, grow rapidly, and then gradually involute. Early diagnosis is crucial, but the clinical presentation of hemangiomas can resemble other vascular anomalies, necessitating the use of imaging studies like ultrasonography (US) in order to establish accurate diagnosis. This study aims to present the ultrasonographic characteristics of a rare case of vulvar hemangioma, with the objective of aiding in its differentiation from other vulvar vascular malformations.

Case Presentation: A 9-year-old girl presented with a painless vulvar mass that had been enlarging over 3 months. Physical examination revealed a 3 x 2.5 x 1.5 cm, well-defined, skin-colored, non-tender, and immobile mass. Greyscale ultrasonography showed a septated cystic lesion with internal echoes. Doppler ultrasonography showed low flow vascular patterns, suggestive of a hemangioma. Surgical excision was performed, and histopathology confirmed the diagnosis of a hemangioma

Results: Although vulvar hemangioma is rare, it can mimic other vascular anomalies, making imaging essential for accurate diagnosis and management. Ultrasonography, as a inexpensive and non-invasive imaging modality, plays a crucial role in differentiating hemangiomas from other vascular malformations.

Conclusion: Hemangioma is a form of vascular mass and the most common one, at early phase the clinical presentation might resemble other vascular anomalies. Thereby diagnostic modalities such as ultrasonography might be able to help to establish the diagnosis

Keywords:

ultrasonography, vulvar hemangioma,vascular tumors

References

Abraham A, Job A, Roga G (2016). Appro-ach to infantile hemangiomas. Indian J Dermatol. 61(2): 181-186. https://-doi.org/10.4103/0019-5154.177755.

Bava GL, Dalmonte P, Oddone M, Rossi U (2002). Life-threatening hemorrhage from a vulvar hemangioma. J Pediatr Surg. 37(4):E6. https://doi.org/10.10-53/jpsu.2002.31645.

Bhat V, Salins PC, Bhat V (2014). Imaging spectrum of hemangioma and vas-cular malformations of the head and neck in children and adolescents. J Clin Imaging Sci. 4: 31. https://doi.-org/10.4103/2156-7514.135179.

Braun V, Prey S, Gurioli C, Boralevi F, Taieb A, Grenier N, Loot M, et al. (2020). Congenital haemangiomas: a single-centre retrospective review. BMJ Paediatr Open. 4(1):e000816. https://doi.org/10.1136/bmjpo-2020-000816.

Cebesoy FB, Kutlar I, Aydin A (2008). A rare mass formation of the vulva: giant cavernous hemangioma. J Low Genit Tract Dis. 12(1): 35-7. https://-doi.org/10.1097/lgt.0b013e3181255e85.

Cheung VYT (2018). Ultrasonography of benign vulvar lesions. Ultrasonogra-phy. 37(4): 355-360. https://doi.org/10.14366/usg.18001.

Cheung VYT, Tse KY (2018). Vulval hemangioma. J Obstet Gynaecol Can. 37(4):355–360. https://doi.org/10.-1016/j.jogc.2017.02.004.

Clemente EJI, Leyva JD, Karakas SP, Duarte AM, Mas TR, Restrepo R (2023). Radiologic and clinical fea-tures of infantile hemangioma: potential pitfalls and differential diagnosis. Radiographics. 43(11): e230064. https://doi.org/10.1148/rg.230064.

da Silva JM, Calife ER, Cabral JVd, de Andrade HPF, Gonçalves AK (2018). Vulvar hemangioma: case report. Rev Bras Ginecol Obstet. 40(6): 369-371. https://doi.org/10.1055/s-0038-165-7786.

DeHart A, Richter G (2019). Hemangioma: recent advances. F1000Res. 8:F1000. https://doi.org/10.12688/f1000research.20152.1.

Ding AA, Gong X, Li J, Xiong P (2019). Role of ultrasound in diagnosis and differential diagnosis of deep infantile hemangioma and venous malformation. J Vasc Surg Venous Lymphat Disord. 7(5): 715-723. https://doi.org-/10.1016/j.jvsv.2019.01.065.

Esposito F, Ferrara D, Di Serafino M, Diplomatico M, Vezzali N, Giugliano AM, Colafati G, et al. (2018). Classifi-cation and ultrasound findings of vascular anomalies in pediatric age: the essential. J Ultrasound. 22(1):13-25. https://doi.org/10.1007/s40477-018-0342-1.

Gangkak G, Mishra A, Priyadarshi S, Tomar V (2015). Large genital cavernous hemangioma: a rare surgically correctable entity. Case Rep Urol. 2015: 1-3. https://doi.org/10.1155/20-15/950819.

Kim J, Son B, Choi J (2018). Venous mal-formation (cavernous hemangioma) of the supraorbital nerve. Asian J Neurosurg. 13(2): 499-502. https://-doi.org/10.4103/ajns.ajns_166_16.

McNab M, García C, Tabak D, Aranibar L, Castro A, Wortsman X (2021). Sub-clinical ultrasound characteristics of infantile hemangiomas that may potentially affect involution. J Ultra-sound Med. 40(6): 1125-1130. https://doi.org/10.1002/jum.15489.

Merlino L, Volpicelli AI, Anglana F, D’Ovidio G, Dominoni M, Pasquali MF, Gardella B (2024). Pediatric hemangiomas in the female genital tract: a literature review. Diseases. 12(3):48. https://doi.org/10.3390/-diseases12030048.

Mundeli S, Gibu S, Kizito M (2024). A rare case of a 5-year-old girl with Klippel–Trénaunay syndrome and a bleeding focal vulvar hemangioma in Uganda. Clin Case Rep. 12(10):e9501. https://doi.org/10.1002/ccr3.9501.

Park HJ, Lee SY, Rho MH, Jung HL (2021). Ultrasound and MRI findings as predictors of propranolol therapy response in patients with infantile hemangioma. PLoS One. 16(3): e024-7505. https://doi.org/10.1371/jour-nal.pone.0247505.

Rodríguez-Bandera AI, Sebaratnam DF, Wargon O, Wong LCF (2021). Infan-tile hemangioma. part 1: epidemio-logy, pathogenesis, clinical presenta-tion and assessment. J Am Acad Der-matol. 85(6):1379-1392. https://doi.-org/10.1016/j.jaad.2021.08.019.

Taner CE, Kayar I, Iris A, Aydogan Kirmizi D, Goklu Y, Goklu R, Ayaz D (2013). Vulvar cavernous hemangioma: case report. Gynecol Obstet Reprod Med. 19(2): 122-124. https://gorm.com.tr/-index.php/GORM/article/view/202.

Verma A, Sharma G, Srivastava N, Verma N (2023). An unusual presentation of vulvar cavernous hemangioma in a 10-year-old premenarchal girl: a rare entity. Int J Reprod Contracept Obstet Gynecol. 12(1): 3199-3201. https://doi.org/10.18203/2320-1770.ijrcog20232974.

Wortsman X (2018). Atlas of dermatologic ultrasound. Cambridge Int Law J. https://link.springer.com/book/10.1007/978-3-319-89614-4.