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Life-Threatening Hemangioma Arising from the Parotid Gland

The parotid hemangioma was first noted when the infant was 1 week old; it appeared as a red stain over the left mandibular angle and progressed to a small swelling by 4 weeks of age. The hemangioma increased in size despite two courses of oral corticosteroids (prednisone, 3 mg/kg/day for 4 weeks, followed 1 month later by prednisone at 4 mg/kg/day for 4 weeks) given between 4 and 7 months of age. By 9 months of age, the infant had tachypnea, dyspnea, and anasarca. At 10 months of age, progressive symptoms of heart failure resulted in admission to a local hospital. Two days later, the patient was transferred to the pediatric cardiology service at our institution because of severe congestive heart failure. At the time the patient was admitted, the hemangioma measured 13 cm in diameter externally, with protrusion of the left tonsil and pharyngeal wall to the midline of the oropharynx. Tachycardia without murmurs or gallops was noted on examination of the heart. Examination of the lungs revealed bilateral rales and ronchi throughout. Examination of the abdomen revealed marked hepatomegaly and splenomegaly. Laboratory values were normal. Sonography of the heart showed a severely dilated right atrium and ventricle, with tricuspid regurgitation and evidence of pulmonary hypertension with cor pulmonale. Ultrasound examination of the abdomen showed a dilated superior mesenteric artery (SMA), with no evidence of an intra-abdominal or hepatic hemangioma. Immediate medical management of