Ultrasonography in the choice of surgical tactics for pyogenic granulomas of the skin in children: a clinical observation

  • Authors: Safin D.A.1,2, Polyaev Y.A.1, Nurmeev I.N.3, Mylnikov A.A.1,2, Mukhtarov I.R.4, Pakholik E.V.5, Amatov D.A.6, Zayalova G.I.3, Pecheritsa O.G.7
  • Affiliations:
    1. Separate structural unit Russian Children's Clinical Hospital of the Federal State Autonomous Educational Institution of Higher Education «Russian National Research Medical University named after N.I. Pirogov» of the Ministry of Health of the Russian Federation, Moscow, Russia
    2. First center «Hemangioma», Moscow, Russia
    3. Federal State Budgetary Educational Institution of Higher Education «Kazan Medical University» of the Ministry of Healthcare of the Russian Federation, Kazan, Russia
    4. Limited Liability Company «Center for Children's Surgery», Ufa, Russia
    5. Medical Center «Doctor Plus», Limited Liability Company «Medical Plus», Obninsk, Russia
    6. Kyrgyz State Medical Academy named after I.K. Akhunbaev, Bishkek, Kyrgyzstan
    7. State Autonomous Institution of Healthcare "Children's Republican Clinical Hospital of the Ministry of Healthcare of the Republic of Tatarstan", Kazan, Russia
  • Section: CASE REPORTS
  • Submitted: 12.04.2025
  • Accepted: 09.06.2025
  • Published: 09.06.2025
  • URL: https://jps-nmp.ru/jour/article/view/864
  • DOI: https://doi.org/10.17816/ps864
  • ID: 864


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

BACKGROUND. Pyogenic granuloma (PG), also known as lobular capillary hemangioma (LCH), is an acquired benign vascular tumor, usually presenting as a solitary papule or nodule on the skin or mucosa, most often occurring in children aged 6–7 years. It is characterized by recurrence and bleeding with minimal trauma, while bleeding can be intense. Ultrasound imaging plays an important role in the differential diagnosis of pyogenic granulomas and the choice of treatment.

CLINICAL CASE DESCRIPTION. In this clinical observation, we present a case of successful laser treatment of a 3-year-old patient with pyogenic granuloma of the skin of the right temporal region. Ultrasound examination (US) in color Doppler mapping mode visualized a single vessel with a diameter of up to 0.09 cm approaching the base of the pyogenic granuloma, which in pulsed wave mode had an antegrade monophasic intermediate resistance blood flow spectrum with a linear blood flow velocity of 17.7 cm / sec. Under local application anesthesia Lidocaine 25 mg / g + Prilocaine 25 mg / g (Akriol-PRO), one session of laser therapy with an Nd: YAG laser was performed in a manner for which a patent was obtained (patent RU No. 2814754 SPK A61B 18/20 (2023.08) - 04.03.2024 Bulletin No. 7). After laser photodestruction, a control ultrasound was performed, in which the feeding vessel was not detected. The follow-up period was 2 years, no relapse was noted.

CONCLUSION. When ultrasound visualizes single vessels approaching the base of the pyogenic granuloma with a diameter of less than 0.5–1.0 mm, laser therapy methods can be used. In the case of multiple vessels approaching the base of the formation and vessels of larger diameter, preference is given to traditional methods of surgical removal followed by histological and immunohistochemical examination.

Full Text

Restricted Access

About the authors

Dinar Adkhamovich Safin

Separate structural unit Russian Children's Clinical Hospital of the Federal State Autonomous Educational Institution of Higher Education «Russian National Research Medical University named after N.I. Pirogov» of the Ministry of Health of the Russian Federation, Moscow, Russia; First center «Hemangioma», Moscow, Russia

Email: safindinar@ya.ru
ORCID iD: 0000-0001-9436-3352
SPIN-code: 7879-7829

PhD; chief of department  of the First center «Hemangioma», Moscow, Russia; pediatric surgeon of the Department of X-ray Surgical Diagnostic and Treatment Methods of the Separate structural unit Russian Children's Clinical Hospital (RDKB FGAOU VO RNIMU named after N.I. Pirogov of the Ministry of Health of the Russian Federation), Moscow, Russia

Россия

Yuri Alexandrovich Polyaev

Separate structural unit Russian Children's Clinical Hospital of the Federal State Autonomous Educational Institution of Higher Education «Russian National Research Medical University named after N.I. Pirogov» of the Ministry of Health of the Russian Federation, Moscow, Russia

Email: polyaev@inbox.ru
ORCID iD: 0000-0002-9554-6414
SPIN-code: 7587-9843

Grand Ph.D. in Medicine, professor; doctor for X-ray endovascular diagnosis and treatment of the Department of X-ray Surgical Diagnostic and Treatment Methods of the Separate structural unit Russian Children's Clinical Hospital (RDKB FGAOU VO RNIMU named after N.I. Pirogov of the Ministry of Health of the Russian Federation), Moscow, Russia

Россия

Ildar Nailevich Nurmeev

Federal State Budgetary Educational Institution of Higher Education «Kazan Medical University» of the Ministry of Healthcare of the Russian Federation, Kazan, Russia

Email: nurmeev@gmail.com
ORCID iD: 0000-0002-1023-1158
SPIN-code: 7406-0564

Grand Ph.D. in Medicine, professor, professor of the Department of Pediatric Surgery Federal State Budgetary Educational Institution of Higher Education «Kazan Medical University» of the Ministry of Healthcare of the Russian Federation, Kazan, Russia

Россия

Andrey Anatolyevich Mylnikov

Separate structural unit Russian Children's Clinical Hospital of the Federal State Autonomous Educational Institution of Higher Education «Russian National Research Medical University named after N.I. Pirogov» of the Ministry of Health of the Russian Federation, Moscow, Russia; First center «Hemangioma», Moscow, Russia

Email: angio.doctor@mail.ru
ORCID iD: 0000-0003-3317-3058
SPIN-code: 2225-1987

PhD; doctor for X-ray endovascular diagnosis and treatment of the Department of X-ray Surgical Diagnostic and Treatment Methods of the Separate structural unit Russian Children's Clinical Hospital (RDKB FGAOU VO RNIMU named after N.I. Pirogov of the Ministry of Health of the Russian Federation), Moscow, Russia

Россия

Islamgaze Rinatovich Mukhtarov

Limited Liability Company «Center for Children's Surgery», Ufa, Russia

Email: islam107@mail.ru
ORCID iD: 0009-0002-7726-0567

Pediatric surgeon Children's Surgery Center, Ufa, Russia

Россия

Elizaveta Vladimirovna Pakholik

Medical Center «Doctor Plus», Limited Liability Company «Medical Plus», Obninsk, Russia

Email: pakholik.usd@yandex.ru
ORCID iD: 0000-0003-3042-7534
SPIN-code: 8866-4068

Ultrasound diagnostics doctor at the medical center "Doctor Plus", Limited Liability Company "Medical Plus", Obninsk, Russia

Россия

Daniyar Apazovich Amatov

Kyrgyz State Medical Academy named after I.K. Akhunbaev, Bishkek, Kyrgyzstan

Email: daniiaramatov@gmail.com
ORCID iD: 0009-0005-1182-6953

Assistant of the department of faculty pediatrics Kyrgyz State Medical Academy named after I.K. Akhunbaev, Bishkek, Kyrgyzstan, Bishkek, Kyrgyzstan

Gulnar Ilnurovna Zayalova

Federal State Budgetary Educational Institution of Higher Education «Kazan Medical University» of the Ministry of Healthcare of the Russian Federation, Kazan, Russia

Author for correspondence.
Email: zayalova-16.03@mail.ru
ORCID iD: 0000-0001-5046-4629

Postgraduate student of the Department of Pediatric Surgery Federal State Budgetary Educational Institution of Higher Education «Kazan Medical University» of the Ministry of Healthcare of the Russian Federation, Kazan, Russia

Россия

Olesya Grigorievna Pecheritsa

State Autonomous Institution of Healthcare "Children's Republican Clinical Hospital of the Ministry of Healthcare of the Republic of Tatarstan", Kazan, Russia

Email: sofiko-05@mail.ru
ORCID iD: 0009-0003-7862-9853

Ultrasound diagnostics doctor of the ultrasound diagnostics department of the State Autonomous Institution of Healthcare "Children's Republican Clinical Hospital of the Ministry of Healthcare of the Republic of Tatarstan", Kazan, Russia

Россия

References

  1. Sarwal P, Lapumnuaypol K. Pyogenic Granuloma. 2024 Sep 10. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 32310537.
  2. Alomari MH, Kozakewich HPW, Kerr CL, Uller W, Davis SL, Chaudry G, Liang MG, Orbach DB, Mulliken JB, Greene AK, Afshar S, Fishman SJ, Taghinia AH, Al-Ibraheemi A, Alomari AI. Congenital Disseminated Pyogenic Granuloma: Characterization of an Aggressive Multisystemic Disorder. J Pediatr. 2020 Nov; 226:157-166. doi: 10.1016/j.jpeds.2020.06.079. Epub 2020 Jul 2. PMID: 32622671.
  3. Gaw CE, Treat JR, Friedlaender EY, Del Pizzo J. Management of Bleeding Pyogenic Granulomas in Acute Care Settings. J Emerg Med. 2022 Sep;63(3):339-347. doi: 10.1016/j.jemermed.2022.04.031. Epub 2022 Oct 6. PMID: 36210284.
  4. Tarasenko G.N., Tarasenko Yu.G., Bekoeva A. V., Protsyuk O. Pyogenic granuloma in the practice of a dermatologist // Russian Journal of Skin and Venereal Diseases. 2017. No. 1. URL: https://cyberleninka.ru/article/n/piogennaya-granulema-v-praktike-vracha-dermatologa (date of access: 12/17/2024). DOI: http://dx.doi.org/10.18821/1560-9588-2017-20-1-50-52.
  5. Gasanova E.N., Gorbatova N.E., Dorofeev A.G., Zolotov S.A., Batunina I.V., Bryancev A.V. Combined laser photodestruction - a method of radical treatment of pyogenic granuloma in children. Pediatric surgery, 2022, 26(4), 207-213. https://doi.org/10.55308/1560-9510-2022-26-4-207-213.
  6. Frydkjær AG, Krogerus C, Løvenwald JB. [Pyogenic granuloma]. Ugeskr Laeger. 2021 Jul 19;183(29):V12200898. Danish. PMID: 34356018.
  7. DQ Pediatric Treatment Editorial Board. Childhood Vascular Tumors Treatment (PDQ®): Health Professional Version. 2024 Sep 16. In: PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US); 2002–. PMID: 26844334.
  8. Lawley LP. Pyogenic granuloma (lobular capillary hemangioma) / L.P.Lawley [Electronic resource] // UpToDate : [Site]. –1991. –URL: https://www.uptodate.com/contents/pyogenic-granuloma-lobular-capillary-hemangioma/print (date viewed: 10.11.2024).
  9. Kaleeny JD, Janis JE. Pyogenic Granuloma Diagnosis and Management: A Practical Review. Plast Reconstr Surg Glob Open. 2024 Sep 13;12 (9):e6160. doi: 10.1097/GOX.0000000000006160. PMID: 39281092; PMCID: PMC11398770.
  10. Su NY, Lu MY, Chang YC. CO2 and diode lasers-combined excision of a recurrent pyogenic granuloma. J Dent Sci. 2021 Oct;16(4):1323-1324. doi: 10.1016/j.jds.2021.03.002. Epub 2021 Mar 19. PMID: 34484610; PMCID: PMC8403797.
  11. Yadav RK, Verma UP, Tiwari R. Non-invasive treatment of pyogenic granuloma by using Nd:YAG laser. BMJ Case Rep. 2018 Aug 9;2018:bcr2017223536. doi: 10.1136/bcr-2017-223536. PMID: 30093461; PMCID: PMC6088279.
  12. Wu JP, Dong LP, Lu XY, Ge HS, Zhang L, Xiao FL. Treatment of pyogenic granuloma in children with a 595 nm pulsed dye laser: A retrospective study of 212 patients. Lasers Surg Med. 2022 Aug;54(6):835-840. doi: 10.1002/lsm.23545. Epub 2022 Apr 8. PMID: 35395702.
  13. Cheng J, Yuan H, Fu R, Jin P, Huang M, Wu Z, Bai H, Huang X, Zou Y. Comparison of the efficacy and adverse effects of long pulsed 1064 nm Nd: YAG laser and sclerotherapy in the treatment of pyogenic granuloma in children: a retrospective study. Sci Rep. 2025 Jan 22;15(1):2843. doi: 10.1038/s41598-025-85401-8. PMID: 39843523; PMCID: PMC11754835.
  14. Patent RUS № 2814754/ 04.03.2024. Byul. №7. Nurmeev IN, Safin DA, Mirolyubov LM, Nurmeev SI. Sposob lazernogo udaleniya piogennoy granulemy. Available from: https://searchplatform.rospatent.gov.ru/doc/RU2814754C1_20240304?q=&from=search_simple&hash=254591896 (In Russ).
  15. Prajapat J, Prajapat R, Khanagar SB, Siddeeqh S. Extragingival pyogenic granuloma of the lower lip masquerading as a vascular lesion. J Oral Maxillofac Pathol. 2022 Feb;26(Suppl 1):S119-S123. doi: 10.4103/jomfp.jomfp_108_21. Epub 2022 Feb 28. PMID: 35450232; PMCID: PMC9017834.
  16. Cantisani V, Del Vecchio A, Fioravanti E, Romeo U, D'Ambrosio F. Color-Doppler US features of a pyogenic granuloma of the upper dorsum tongue. J Ultrasound. 2014 Aug 5;19(1):67-70. doi: 10.1007/s40477-014-0121-6. PMID: 26941877; PMCID: PMC4762846.
  17. Gonzalez C, Duque-Clavijo V, Cantor J, Duque-Romero HE. Dermatological Ultrasound of Less Frequent Dermatological Vascular Anomalies: A Retrospective Study and Literature Review From a Reference Center in Bogotá, Colombia. Cureus. 2024 Sep 28;16(9):e70400. doi: 10.7759/cureus.70400. PMID: 39473670; PMCID: PMC11518829.
  18. Browning JC, Eldin KW, Kozakewich HP, Mulliken JB, Bree AF. Congenital disseminated pyogenic granuloma. Pediatr Dermatol. 2009 May-Jun;26(3):323-7. doi: 10.1111/j.1525-1470.2008.00858.x. PMID: 19706097.
  19. Piłat P, Borzęcki A, Jazienicki M, Gerkowicz A, Krasowska D. High-frequency ultrasound in the diagnosis of selected non-melanoma skin nodular lesions. Postepy Dermatol Alergol. 2019 Oct;36(5):572-580. doi: 10.5114/ada.2019.89505. Epub 2019 Nov 12. PMID: 31839774; PMCID: PMC6906959.
  20. McNab M, García C, Tabak D, Aranibar L, Castro A, Wortsman X. Subclinical Ultrasound Characteristics of Infantile Hemangiomas That May Potentially Affect Involution. J Ultrasound Med. 2021 Jun;40(6):1125-1130. doi: 10.1002/jum.15489. Epub 2020 Sep 8. PMID: 32896906.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) Safin D.A., Polyaev Y.A., Nurmeev I.N., Mylnikov A.A., Mukhtarov I.R., Pakholik E.V., Amatov D.A., Zayalova G.I., Pecheritsa O.G.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies