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Early-detection demo · Segmental hemangioma → PHACE workup

Pediatric vascular AI flagged the segmental + V3 distribution that mandates MRA brain

Segmental infantile hemangioma in S3 (mandibular) + S1 (frontotemporal) distribution — PHACE syndrome workup required.

Patient: Aria · 4 months · facial hemangiomaModality: DERMRisk: high · 70/100
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01

Risk profile

What OCTON knew before the scan
Risk
70
high
Tier
high
Female · 32-week premature · birth weight 1.8 kg · rapidly proliferating right-cheek-and-mandible hemangioma since week 3 of life.
Contributing factors
  • Segmental (not focal) hemangioma distribution+28
  • Facial location (S1 + S3 segments involved)+22
  • Female sex (PHACE 9:1 female predominance)+10
  • Premature (<37 wk) + low birth weight+6
  • Onset week 3 (proliferative phase)+4
Narrative

Aria meets ≥1 major criterion (segmental facial hemangioma >5 cm). Per Garzon et al. 2016 PHACE consensus, MRI/MRA brain + echocardiogram + ophthalmology evaluation are mandatory to rule out the associated arterial, cardiac, and ocular anomalies before initiating propranolol.

01.5

Cinematic findings

Bayesian posterior · Hebbian cross-specialty co-activation
Bayesian posterior
PHACE syndrome
22.7×
Lift
Pretest 1.5%→Posterior 34.0%
Evidence chain · LR per signal
  • Female infantLR ×1.0
    Garzon et al · J Pediatr 2016 — PHACE prevalence 4× higher in female infants.
  • Segmental (not focal) hemangiomaLR ×8.0
    Metry et al · Pediatrics 2009;124:1447 — segmental morphology is THE single strongest PHACE predictor.
  • Facial S1+S3 distributionLR ×4.2
    Haggstrom et al · Pediatrics 2010;126:e418 — frontotemporal + mandibular distribution carries highest PHACE association.
  • Size > 22 cm² (large)LR ×1.6
    Garzon · J Pediatr 2016 — lesion size >22 cm² independently raises associated-anomaly risk.
Cross-specialty co-activation
Primary: Pediatric
4
Edges fired
Pediatric↔Dermatology
94%
Skin lesion as primary presentation
Pediatric↔Neurology
71%
Segmental distribution → cerebrovascular anomaly screening
Pediatric↔Cardiology
62%
Aortic arch anomaly co-occurrence in PHACE
Pediatric↔Ophthalmology
45%
Posterior segment / ocular anomaly screening
01.75

Lifespan forecast

Where you'll be in 30 years · with vs without intervention
Without intervention
62.0years
−18.5 years vs baseline
With OCTON intervention
79.8years
Returns to ~baseline (80.5 yrs)
Net years protected
+17.8years · 17.8 QALYs
10-yr event risk: 18% → 2%
-2122640546882+0y+5y+10y+15y+20y+25y+30y62.0 yrs79.8 yrsFORECAST · 30-YEAR LIFE EXPECTANCY · AGE 0 → AGE 30
No intervention With OCTON Baseline US life table
EvidenceGarzon Pediatrics 2016 PHACE consensus — pre-treatment MRA + echo screening avoids beta-blocker-induced cerebrovascular events in pts with undetected vertebral artery anomalies. Expected QALY preservation is enormous given the patient's young age.
How to actually realise the gain

These are the specific levers OCTON puts on your plan — each one comes with the expected impact below.

drug
Oral propranolol 1→2 mg/kg/day × 12 months (after cardiac clearance)
Hemangioma involution 70% by 12 months
scan
MRA brain + neck + echocardiogram BEFORE propranolol
Excludes PHACE arterial / aortic anomaly
lifestyle
Serial dermatology photographic mapping
Tracks involution; airway concerns flagged early
diet
Standard infant feeding + iron-fortified formula
Supports normal growth on beta-blocker
02

Scan + AI report

What DERM found · High-resolution dermatologic imaging + photographic mapping
DERM · DEMO
Hemangioma Investigator Group classification Segmental
OCTON · scanning · live
conf 0.85
OCTON Impression · 88% confidence

Right-sided plaque-like segmental hemangioma involving the mandibular (S3) and frontotemporal (S1) segments, total surface area ~24 cm². Bright-red telangiectatic surface with subcutaneous deep component. Lesion has grown ~30% in the past 4 weeks (proliferative phase).

Findings
  • Segmental plaque involving S1 + S3 facial segments · Right hemiface240 mm
  • Telangiectatic superficial + deeper subcutaneous component · Hemangioma
  • 30% surface growth in 4 weeks (proliferative phase) · Hemangioma
  • No ulceration, no airway obstruction visible externally · Hemangioma
Differential diagnosis
  • Segmental infantile hemangioma (GLUT-1+)92%
  • Tufted angioma / kaposiform hemangioendothelioma4%
  • Congenital hemangioma (NICH/RICH)3%
  • Capillary malformation (port-wine)1%
Recommended actions
  • ▸MRI + MRA brain + neck within 1 week (rule out cerebrovascular anomalies)
  • ▸Echocardiogram + aortic arch imaging (coarctation surveillance)
  • ▸Ophthalmology consult (posterior eye anomalies)
  • ▸Initiate oral propranolol 1 mg/kg/day after cardiac clearance — first-line per AAP 2019
Caveats
  • Beta-blocker therapy contra-indicated until cardiac anomalies excluded.
  • S3 hemangiomas have higher rate of airway involvement (subglottic) — monitor for stridor.
03

360° Preventative plan

Drugs · surveillance · diet · exercise · lifestyle — generated for this case
Clinical anchors
Drugs · labs · imaging · surveillance
Medical
Oral propranolol 1 mg/kg/day → 2 mg/kg/day target
FrequencyDaily x 12 months (proliferative + involution)
Startsage 0
AAP 2019 IH guideline — first-line
Medical
Serial photographic + size mapping
FrequencyMonthly first 6 months, then every 3 months
Startsage 0
Dermatology longitudinal follow-up
Monitoring
MRI + MRA brain/neck (PHACE workup)
FrequencyOnce at presentation; repeat per neuro findings
Startsage 0
Garzon Pediatrics 2016 PHACE consensus
Monitoring
Echocardiogram + arch imaging
FrequencyOnce at presentation
Startsage 0
Same consensus
Lifestyle 360°
Diet · exercise · sleep · stress — the behaviours that move the needle
Diet
Infant nutrition on propranolol
  • ▸Breastfeed on demand OR iron-fortified infant formula
  • ▸Give propranolol WITH a feed to prevent hypoglycaemia
  • ▸Vitamin D 400 IU/day from week 1 of life (AAP universal)
  • ▸Stop feeds 30 min before propranolol if vomiting concern
  • ▸Parents track wet nappies + weight gain weekly (red flag if <120 g/wk)
FrequencyPer feeding schedule
Startsage 0
AAP IH 2019 + dietetic infant-feeding guideline
Exercise
Developmental milestones · tummy-time
  • ▸Tummy-time 3-5×/day for 5-10 min from age 1 mo
  • ▸Rolling by 4 mo · sitting by 6 mo · cruising by 9 mo — flag delays
  • ▸Avoid prolonged bouncer/jumper time (>30 min/day)
  • ▸Mirror play encourages eye tracking (relevant given S1 segment + ocular workup)
FrequencyDaily
Startsage 0
AAP motor-development surveillance 2024
Lifestyle
Family caregiver education + environment
  • ▸Parental teaching: signs of hypoglycaemia (lethargy, sweating, jitteriness)
  • ▸Stridor or feeding difficulty → ER same day (subglottic hemangioma risk)
  • ▸Sun-protection on hemangioma (zinc-oxide SPF 30+) during outings
  • ▸Photograph the lesion weekly under same lighting for involution tracking
  • ▸Family psych-support — visible facial differences in infants is stressful
FrequencyInitial visit + monthly review
Startsage 0
AAP IH 2019 family-centred care guideline
04

What changed

The early-detection win

Aria's parents brought her in worried about the rapidly-growing facial mark. The OCTON pediatric vision AI didn't just classify the lesion — it noticed the segmental rather than focal distribution and the S1+S3 involvement that mandates a PHACE workup BEFORE starting propranolol. MRA confirmed an aberrant right vertebral artery; echo was normal. Propranolol started safely under cardio supervision. By 14 months the hemangioma had involuted by 70%. Without the segmental flag, Aria would have started propranolol on day one and the vertebral anomaly would have been missed entirely — with potential beta-blocker-induced cerebrovascular compromise.

Run this for yourself

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