Modern Pediatrics. Ukraine. (2025).5(149): 143-150. doi: 10.15574/SP.2025.5(149).143150
A.A. Malska¹, O.B. Kurilyak², O.V. Stogova³, Raad Tammo³, B.Ya. Malovanyy^2
1Danylo Halytsky Lviv National Medical University, Ukraine
²Center for Pediatric Medicine "OKHMATDYT", Lviv, Ukraine
³SI "Scientific and Practical Medical Center for Pediatric Cardiology and Cardiac Surgery of the Ministry of Health of Ukraine", Ukraine

For citation: Malska AA, Kurilyak OB, Stogova OV, Tammo Raad, Malovanyy BYa. (2025). Mediastinal hemangioma and aortic coarctation – a rare combination (a clinical case). Modern Pediatrics. Ukraine. 5(149): 143-150. doi: 10.15574/SP.2025.5(149).143150.
Article received: Mar 22, 2025. Accepted for publication: Sep 10, 2025.

Coarctation of the aorta (CoA) is a congenital heart defect characterized by narrowing of the aortic lumen, most often in the region of the isthmus, leading to impaired systemic blood flow. Hemangioma is a benign vascular tumor that occurs in about 10% of infants, more frequently in girls. In most cases, they are asymptomatic; however, when large, they may compress adjacent structures such as the aorta or airways, leading to hemodynamic compromise or respiratory disorders.
Aim – to present a clinical case of a rare combination of a cutaneous hemangioma of the chest wall, a mediastinal hemangioma, and coarctation of the aorta in a one-month-old infant, highlighting the diagnostic and therapeutic challenges.
Clinical case. A one-month-old infant, born at 35 weeks of gestation as the second of twins conceived via in vitro fertilization, was noted to have a large hemangioma on the anterior chest wall. Before initiating beta-blocker therapy, the child was referred to a cardiologist, and echocardiography revealed coarctation of the aorta with a high pressure gradient. Computed tomography of the chest revealed a massive mediastinal vascular tumor extending to major vessels, which precluded radical surgical repair of the heart defect due to the high risk of massive intraoperative bleeding. Under these circumstances, balloon angioplasty was performed, resulting in partial reduction of the pressure gradient, after which beta-blocker therapy was initiated, with the plan for radical correction following hemangioma regression.
Conclusions. In our case, the chest wall hemangioma prompted extended diagnostic evaluation, which enabled timely identification of not only the mediastinal tumor but also coarctation of the aorta. This emphasizes the importance of comprehensive evaluation of children with hemangiomas to rule out associated vascular anomalies, including aortic arch involvement and PHACES syndrome.
The study was conducted in accordance with the principles of the Declaration of Helsinki. Informed consent was obtained from participant.
The authors declare no conflict of interest.
Keywords: mediastinal hemangioma, coarctation of the aorta, balloon dilatation, children.

REFERENCES

1. AbouZeid AA, Mohammad SA, Aly HG, Ragab IA. (2021, Jan). Posterior Mediastinal and Cutaneous Back Hemangiomas in Infants: A New Association. European J Pediatr Surg Rep. 9(1): e37-e40. Epub 2021 May 12. https://doi.org/10.1055/s-0040-1721408; PMid:34007781 PMCid:PMC8116171

2. Andreassi MG and Della Corte A, Genetics of bicuspid aortic valve aortopathy. Curr Opin Cardiol, 2016. 31(6): p. 585-592. https://doi.org/10.1097/HCO.0000000000000328; PMid:27583373

3. Ceyhan M, Elmali M, Yildiz L. (2008). Mediastinal Hemangioma and Accompanying Aortic Arch Anomaly. Pediatr Cardiol. 29: 867-869. https://doi.org/10.1007/s00246-007-9192-x; PMid:18183452

4. Das KM, Ahmed AM, Aljubab A, Alzoum MA. (2013). Multidetector computed tomography evaluation of cavernous haemangioma of the azygous vein. Interact Cardiovasc Thorac Surg. 17(2): 436-437. https://doi.org/10.1093/icvts/ivt126; PMid:23660735 PMCid:PMC3715163

5. Feinberg SB. (1957). Posterior mediastinal hemangioma. Radiology. 68(1): 90-93. https://doi.org/10.1148/68.1.90; PMid:13401023

6. Fink C, Peuster M, Hausdorf G. (2000). Endovascular stenting as an emergency treatment for neonatal coarctation. Cardiol Young. 10: 644-646. https://doi.org/10.1017/S1047951100008969; PMid:11117401

7. Ishii K, Maeda K, Hashihira M, Miyamoto Y, Kanegawa K, Kusumoto M et al. (1990). MRI of mediastinal cavernous hemangioma. Pediatr Radiol. 20(7): 556-557. https://doi.org/10.1007/BF02011391; PMid:2216593

8. Kenny D, Hijazi ZM. (2011). Coarctation of the aorta: from fetal life to adulthood. Cardiol J. 18(5): 487-495. https://doi.org/10.5603/CJ.2011.0003; PMid:21947983

9. Kim YY, Andrade L, Cook SC. (2020). Aortic Coarctation. Cardiol Clin, 38(3): 337-351. https://doi.org/10.1016/j.ccl.2020.04.003; PMid:32622489

10. Mardani P, Kamran H, Geramizadeh B et al. (2023). Cavernous mediastinal hemangioma presenting with persistent cough: a rare case report and review of literature. J Cardiothorac Surg. 18: 3. https://doi.org/10.1186/s13019-023-02130-7; PMid:36604701 PMCid:PMC9817268

11. Matitiau A, Birk E, Schonfeld T, Zalzstein E, Berant M, Bruckheimer E. (2002), Stent implantation for long-segment coarctation of aorta in infant with facial and mediastinal hemangioma. Cathet. Cardiovasc. Intervent. 55: 510-512. https://doi.org/10.1002/ccd.10158; PMid:11948901

12. Mineo TC, Biancari F, Cristino B, D'Andrea V. (1995). Benign vascular tumours of the mediastinum: presentation of three cases and review of the literature. Thoraci Cardiovasc Surg. 43(6): 361-364. https://doi.org/10.1055/s-2007-1013811; PMid:8775864

13. Moran CA, Suster S. (1995). Mediastinal hemangiomas: a study of 18 cases with emphasis on the spectrum of morphological features. Hum Pathol. 26(4): 416-421. https://doi.org/10.1016/0046-8177(95)90143-4; PMid:7705821

14. Nicholson GT, Kelleman MS, De la Uz CM, Pignatelli RH, Ayres NA, Petit CJ. (2017, May). Late outcomes in children with Shone's complex: a single-centre, 20-year experience. Cardiol Young. 27(4):697-705. Epub 2016 Jul 26. https://doi.org/10.1017/S1047951116001104; PMid:27456367

15. Prada F, Mortera C, Bartrons J, Rissech M, Jiménez L, Carretero J et al. (2010, Nov). Complex aortic coarctation and PHACE syndrome. Rev Esp Cardiol.;63(11):1367-1370. PMID: 21070732. https://doi.org/10.1016/S1885-5857(10)70261-9

16. Rodríguez Bandera AI, Sebaratnam DF, Wargon O, Wong LF. (2021, Dec). Infantile hemangioma. Part 1: Epidemiology, pathogenesis, clinical presentation and assessment. J Am Acad Dermatol. 85(6): 1379-1392. Epub 2021 Aug 19. https://doi.org/10.1016/j.jaad.2021.08.019; PMid:34419524

17. Rosenberg D. (1962). Hemangioma of the mediastinum. Am J Surg. 103(6): 749-754. https://doi.org/10.1016/0002-9610(62)90260-X; PMid:14493943

18. Rotaru N, Maliga O, Crivcheanschii M, Codreanu I, Repin O, Munteanu A. (2016). Mediastinal cavernous hemangioma in a child with pulmonary hypertension. 1: Article 1086.

19. Salciccioli KB, Zachariah JP. (2023, Oct). Coarctation of the Aorta: Modern Paradigms Across the Lifespan. Hypertension. 80(10): 1970-1979. Epub 2023 Jul 21. https://doi.org/10.1161/HYPERTENSIONAHA.123.19454; PMid:37476999 PMCid:PMC10530495

20. Taşoğlu İ, Özışık K, Küçüker ŞA, Sert D, Mavitaş B, Paç M. (2011, Nov). Aortic coarctation in the presence of capillary hemangioma. Ann Vasc Surg. 25(8): 1143.e7-9. Epub 2011 Jul 20. https://doi.org/10.1016/j.avsg.2011.05.002; PMid:21764546

21. Vaillant L, Lorette G, Chantepie A et al. (1988). Multiple cutaneous hemangiomas and coarctation of the aorta with right aortic arch. Pediatrics. 88: 707-710. https://doi.org/10.1542/peds.81.5.707; PMid:3357730