Digital subtraction angiography and trans arterial embolization in preventing massive hemorrhage of Kaposiform hemangioendothelioma: A case report

The management of hypervascularity tumor in infants and children is challenging due to its hemorrhage risk which can be life threatening. A proper and precise approach should be performed in preventing massive bleeding. A one-month-old male infant came with hypovolemic shock due to intratumor hemorrhage on the right chest that presented at birth and grew progressively with a size of 20 × 15 × 7 cm. After stabilization, Magnetic resonance imaging and Doppler ultrasonography of the tumor showed a solid lesion with an increase in vascular flow. He underwent two rounds of digital subtraction angiography (DSA) and trans arterial embolization (TAE) on the internal mammary, superior thoracic, and right thoracoacromial arteries. On the sixth day after second embolization and ensure significantly reduced vascularity using the ultrasound Doppler modality, he performed tumor removal surgery and skin grafted closure. There were no post-embolization or post-operative complications. Histopathological examination with immunohistochemistry staining on the tumor tissue indicated as Kaposiform hemangioendothelioma. Fluoroscopic technique of DSA and TAE should be considered prior to the tumor removal surgery has been proven to be safe and effective options in progressive large mass with high vascular flow management.