An angioma is essentially an abnormal development in the blood vessels, the exact cause of which is not yet known in detail. However, angiomas are often congenital.
Angiomas consist of the vascular tangle of an artery and a vein, through whose direct connection the artery releases blood into the vein. A distinction is made between developmental angiomas and tumor-like angiomas.
Developmental angiomas usually occur where blood flows directly from an artery into a vein. These include angiectasias, varices, cavernomas and arteriovenous malformations. On the other hand, there are tumor-like angiomas, such as hemangiomas and lymphangiomas.
Angiomas - commonly known as hemangiomas - often occur on the skin of the face, eyelids, nose, lips, neck or spread over the trunk. Angiomas are usually visible on the skin as small red, flat to raised nodules and are harmless.
A small angioma on the skin © waranyu #221240842 | AdobeStock
If such angiomas of the skin occur after the age of 40, they are usually age-related angiomas (angioma seniles), which can also develop in isolated cases or in large numbers due to age. If "blood clotting" (thrombosis) occurs inside these vascular clusters, the senile angiomas can take on an almost black color and harden. In this case, you should always consult a dermatologist (skin specialist ) in order to differentiate the angioma from a nodular, malignant melanoma ("black skin cancer") without any doubt.
In principle, however, angiomas can also occur in all major organs of the body. Within organs such as the liver or heart, doctors refer to them as cavernous hemangiomas or cavernomas for short. In the brain, these vascular anomalies can even have serious health consequences for patients.
Angiomas of the skin are asymptomatic in the majority of cases. Although they can grow to a few millimetres to a few centimetres in size, they usually disappear again in childhood. There is usually only an indication for the removal of cutaneous angiomas if there is repeated mechanical irritation in unfavorable areas of the body.
In about 2-4% of brain angiomas (= cerebral angiomas), however, bleeding can occur, leading to neurological deficits, loss of consciousness and/or acute headaches. Depending on the extent of such bleeding events, there is even a danger to life.
Furthermore, cases have been described in which angiomas have caused seizures. This may be caused purely mechanically by the proximity of the convulsing structures to the angioma, or it may be due to a lack of oxygen caused by the angioma.
Cerebral angiomas also lead to circulatory disorders in the brain, so that depending on the location of the angioma, a variety of other symptoms can occur, such as visual disturbances, paralysis or speech disorders as well as changes in personality.
While skin angiomas can be easily detected by visual diagnosis due to their shape and red coloration, organ angiomas, such as cerebral angiomas in the brain, can only be diagnosed using special imaging techniques.
Traditionally, angiomas in the organs of the body are visualized using angiography, in which a contrast medium flows through all the blood vessels and makes the blood flow visible. Nowadays, however, angiography is increasingly being replaced by a more modern procedure, magnetic resonance imaging(MRI). This makes it possible to obtain high-resolution images of the inside of the head, for example.
Nevertheless, cerebral angiomas / cavernomas are often purely incidental findings as long as there is no bleeding that is accompanied by symptoms of loss. In the latter case, an emergency CT scan is usually performed in the hospital, a so-called computer tomography, which can detect cerebral hemorrhages very quickly.
If an asymptomatic cerebral angioma is detected, there is still a 50% risk that it could lead to bleeding in life. For this reason, doctors usually advise treatment depending on the situation.
There are currently three different options for the treatment of cerebral angiomas:
Embolization involves injecting an adhesive agent via a catheter that is advanced into the cerebral vessels, which seals the vessels of the angioma. However, there is a risk that the agent may enter other fine cerebral vessels and cause further circulatory damage there.
However, if the angioma is easy to reach, it should be surgically removed. This reduces the size of the angioma and reduces the risk of bleeding. On the other hand, this surgical method also carries risks, e.g. the blood vessel could be injured or blood clots released, which in turn can damage other areas of the brain.
Cerebral angiomas that are difficult to access surgically are irradiated stereotactically. The radiation triggers growth in the vascular cells, which very slowly - over a period of years - grow into the vascular lumen and thus closethe vascular tangle of the angioma from the inside. After three years, around 80% of cerebral angiomas treated in this way are closed.
Angiomas are vascular malformations and as such are primarily treated by specialists in angiology (angiologists). Angiology is a branch of internal medicine and specializes in the diagnosis and treatment of vascular diseases.
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