Rapidly involuting congenital haemangioma (RICH) is a benign neoplasm that may occur in many locations in the body. When RICH occurs in the liver, it may be confused with other lesions. These are the rapidly involuting congenital hemangioma (RICH) and the noninvoluting congenital hemangioma (NICH). 16-19 An understanding of these recently discovered entities is still in its infancy. Figure 74-1. •Responds to Propranolol •Rapid proliferation followed by involution. Congenital Hemangiomas •2 types Rapidly involuting congenital hemangioma (RICH) Non-involuting congenital hemangiomas (NICH) •Difficult to distinguish •GLUT-1 negative •Medical therapy ineffective for RICH •NICH may require laser or other surgical therapy. Lobular Capillary Hemangioma •AKA “ pyogenic. We ruled out differential diagnosis including non-involuting congenital hemangioma, congenital-onset tufted angioma, venous malformation (cavernous hemangioma) and lymphatic malformation (cavernous lymphangioma, cystic hygroma). A rapidly involuting congenital hemangioma (RICH) is fully or near-fully developed at birth, with a preference for the head, neck and lower extremities. There is an equal gender distribution. The hemangioma involutes spontaneously within the first 14-18 months of life. Summary. Rapidly involuting congenital haemangiomas (RICHs) are rare benign vascular tumours of infancy. They are generally asymptomatic, but can present with thrombocytopaenia and coagulopathy. Rapidly involuting congenital hemangiomas (RICH) are rare vascular tumors which are characterized for being fully developed at birth and involute completely and spontaneously within six to. Differential diagnoses include infantile haemangioma, which starts to proliferate after birth, and non-involuting congenital haemangioma, which never involutes and grows proportionally with the patient.2, 3 Commonly, a wait-and-see strategy is recommended. Congenital hemangiomas are benign vascular tumors of childhood that are present at birth. They are mostly indistinguishable from infantile hemangioma on imaging but have distinct histological and clinical features. Abstract. Rapidly involuting congenital hemangioma (RICH) is an uncommon vascular tumor that, unlike infantile hemangioma, is largely developed at birth and undergoes rapid postnatal involution.