A 2-month-old girl presents to the pediatric outpatient clinic with a small mass inferior to her right medial canthus (Fig 1). The area was noted to be slightly raised at birth but has become more apparent following an episode of coldlike symptoms at 1 month of age. The lesion increases in size, develops a bluish hue, and becomes more prominent with crying. There is no fever, eyelid edema, ocular discharge, conjunctival injection, or respiratory distress. The infant has prominent veins on her right upper eyelid that are unchanged since birth. The patient was born at 39 weeks’ and 2 days’ gestation via vaginal delivery to a 33-year-old woman with a history of bipolar disorder. The pregnancy was complicated by tobacco and marijuana use. Prenatal medications included a multivitamin, cyclobenzaprine, promethazine, famotidine, loratadine, and hydroxyzine. The infant is growing and developing well. There is no significant family history.
On physical examination, the girl is alert, active, and well-appearing with normal vital signs. Inferior to her right medial canthus is a well-demarcated, compressible, nontender violaceous nodule ∼1 × 1 cm in size, with an overlying superficial telangiectasia. There is no bleeding, ulceration, thrills, or warmth of the nodule. Extraocular movements are intact, red reflex is symmetric bilaterally, and there is no conjunctival injection, tearing, or discharge. On the right upper eyelid are prominent veins. On the glabella and bilateral upper eyelids are erythematous, blanching macules consistent with a nevus simplex. All other physical examination findings are normal.
A diagnosis of a localized, deep infantile hemangioma (IH) is made based on clinical examination. A deep IH located inferior to the medial canthus can be difficult to distinguish clinically from other causes of periorbital masses. However, the blue hue, overlying telangiectasia, and proliferation …