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

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Abstract

Pyogenic granuloma, also known as lobular capillary hemangioma, is an acquired benign vascular tumor, it usually presents as a solitary papule or nodule on the skin or mucosa; in children, it most often occurs at the age of 6–7 years. Pyogenic granuloma is characterized by recurrence and bleeding with minimal trauma. Ultrasound imaging plays an important role in the differential diagnosis of pyogenic granulomas and the choice of treatment method.

In this clinical observation, we present a case of successful laser treatment of a 3-year-old patient with pyogenic granuloma of the skin in the right temporal region. Ultrasound examination in color Doppler mapping mode visualized a single vessel up to 0.09 cm in diameter approaching the base of the pyogenic granuloma, which had an antegrade monophasic intermediate-resistance blood flow spectrum with a linear velocity of 17.7 cm/sec in pulsed-wave in mode. One session of Nd:YAG laser therapy was performed under local application anesthesia Lidocaine 25 mg/g + Prilocaine 25 mg/g. After laser photodestruction, a control ultrasound examination was performed, during which the feeding vessel was not detected. The follow-up period was 2 years, no relapse was noted.

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.

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About the authors

Dinar A. Safin

Russian Children's Clinical Hospital

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

MD, Cand. Sci. (Medicine)

Россия, Moscow

Iurii A. Polyaev

Russian Children's Clinical Hospital

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

MD, Dr. Sci. (Medicine), Professor

Россия, Moscow

Ildar N. Nurmeev

Kazan State Medical University; Children's Republican Clinical Hospital

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

MD, Dr. Sci. (Medicine), Professor

Россия, Kazan; Kazan

Andrey A. Mylnikov

Russian Children's Clinical Hospital

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

MD, Cand. Sci. (Medicine)

Россия, Moscow

Islamgaze R. Mukhtarov

Center for Children's Surgery

Email: islam107@mail.ru
ORCID iD: 0009-0002-7726-0567
SPIN-code: 8176-0040
Россия, Ufa

Elizaveta V. Pakholik

Medical Plus

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

Daniiar A. Amatov

I.K. Akhunbaev Kyrgyz State Medical Academy

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

Gulnar I. Zayalova

Kazan State Medical University

Author for correspondence.
Email: zayalova-16.03@mail.ru
ORCID iD: 0000-0001-5046-4629
SPIN-code: 3810-7010
Россия, Kazan

Olesya G. Pecheritsa

Children's Republican Clinical Hospital

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

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Supplementary files

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2. Fig. 1. Patient, 6 y.o. Diagnosis: "Pyogenic granuloma of the left cheek": on the skin of the left cheek there is a red, rounded formation in the form of a papule with a diameter of 3 mm.

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3. Fig. 2. Patient, 7 y. o. Pyogenic granuloma in the area of the capillary malformation in the left cheek: there is a light red spot with clear boundaries; on the spot surface there is a red formation, 5 mm in diameter, with a skin defect in the form of a crust, on a wide base which rises above the surface of the skin.

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4. Fig. 3. Patient, 10 y.o. Diagnosis: "Pyogenic granuloma of the upper eyelid of the left eye": a, patient’s appearance (in the area of the outer edge of the upper eyelid of the left eye, a red formation with a diameter of about 2 mm is determined, which rises above the surface of the skin); b, in B-mode, a hypoechoic formation of a rounded shape is determined on the surface of the skin, which does not penetrate the dermis; с, in color Doppler mode, blood flow in the formation is determined in the form of a single vessel; d, the blood flow in the formation is monophasic and low velocity.

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5. Fig. 4. Patient, 8 months, after an attempt to stop bleeding from a pyogenic granuloma located in the area of the right cheek by ligation: a formation is detected in the area of the right cheek, at the base of which a ligature is applied.

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6. Fig. 5. The patient's appearance upon admission: a red formation on a wide base of the right temporal region, which rises above the surface of the skin, is detected on the skin.

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7. Fig. 6. Ultrasound examination: in the color Doppler mapping mode, a single vessel with diameter up to 0.09 cm approaching the base of the pyogenic granuloma is visualized (a); in pulsed-wave Doppler mode, in the afferent vessel the antegrade mainstream-changed blood flow spectrum with the maximum linear blood flow velocity of 17.7 cm/sec is visualized (b).

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8. Fig. 7. Control ultrasound examination: immediately after laser photodestruction, a hyperechoic area (coagulation zone) is visualized; there is no visualization of vessels in Doppler energy mode.

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9. Fig. 8. Patient’s appearance after laser photodestruction of pyogenic granuloma: a superficial white skin defect (coagulation zone) is noted, which is smaller than granuloma base.

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10. Fig. 9. Schematic ultrasound picture with Dopplerography: a, pyogenic granuloma (a single vertically oriented linear vessel approaches the subcutaneous fat tissue at the lower pole of the formation); b, infantile hemangioma (multiple vessels approaching the formation in the subcutaneous fat tissue).

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