Cavernous liver hemangioma

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Cavernous liver hemangioma
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Hemangioma of the liver as seen on ultrasound
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A cavernous liver hemangioma or hepatic hemangioma is a benign tumor of the liver composed of large vascular spaces lined by monolayer hepatic endothelial cells. It is the most common benign liver tumour, and is usually asymptomatic and diagnosed incidentally on radiological imaging or during laparotomy for other intra-abdominal issues. Liver hemangiomas are thought to be congenital in origin with an incidence rate of 0.4 – 7.3% as reported in autopsy series. [1] [2]

Contents

Several subtypes exist, including the giant hepatic haemangioma (>10cm), which can cause significant complications.

Diagnosis

Liver hemangiomas are typically hyperechoic on ultrasound though may occasionally be hypoechoic; ultrasound is not diagnostic. Computed tomography (CT), [3] magnetic resonance imaging (MRI) [4] or single-photon emission computed tomography (SPECT) using autologous labelled Red Blood Cells (RBC) with Tc-99m is diagnostic. Biopsy is avoided due to the risk of haemorrhage.[ citation needed ]

Hepatic hemangiomas can occur as part of a clinical syndrome, for example Klippel–Trénaunay syndrome, Osler–Weber–Rendu syndrome and Von Hippel–Lindau syndrome.


Types

Giant hepatic hemangioma

This large, atypical hemangioma of the liver may present with abdominal pain or fullness due to hemorrhage, thrombosis or mass effect. It may also lead to left ventricular volume overload and heart failure due to the increase in cardiac output which it causes. [5] Further complications are Kasabach–Merritt syndrome, a form of consumptive coagulopathy due to thrombocytopaenia, and rupture.

Imaging follow-up

A United States practice is to perform liver ultrasound at 6 months and 12 months after the initial diagnosis, and if the size has not increased, further follow-up is not necessary. [6] Particular situations that may indicate imaging are: [6]

Surgical treatment

For most patients, the natural history of cavernous hemangiomas in the liver remains uneventful, and surgical intervention can be avoided. The observation of asymptomatic lesions with routine follow-up with CT scan or ultrasonography is often sufficient. Indications for the surgical removal of hemangioma may include the development of pain, especially in patients with rupture, rapidly enlarging lesions, profound thrombocytopenia, or an uncertain diagnosis of a liver mass. Surgery for large masses is performed with enucleation or resection. [7]

The surgical procedure is the choice of the individual surgeon – the commonest being enucleation and resection. Massive blood loss can occur during surgery and may result in an operative mortality. Though liver resections can be safely accomplished in specialised units, occasional postoperative complications (bile leak) do occur. Enucleation may represent a safer surgical option with fewer complications for the treatment of haemangiomas, especially in centres with limited experience in liver resections. Most patients fully recover from the procedure and are only hospitalized for less than one week after the procedure. [8]

See also

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References

  1. Singh, R. K.; Kapoor, S.; Sahni, P.; Chattopadhyay, T. K. (2007). "Giant Haemangioma of the Liver: Is Enucleation Better than Resection?". Annals of the Royal College of Surgeons of England. 89 (5): 490–493. doi:10.1308/003588407X202038. PMC   2048596 . PMID   17688721.
  2. Baron R. 'Liver: Masses Part I: detection and characterization' Archived 2012-10-29 at the Wayback Machine . The Radiology Assistant 2006
  3. Brodsky RI, Friedman AC, Maurer AH et-al. Hepatic cavernous hemangioma: diagnosis with 99mTc-labeled red cells and single-photon emission CT. AJR Am J Roentgenol. 1987;148 (1): 125-9. PMID   3491500
  4. Vilanova JC, Barceló J, Smirniotopoulos JG et-al. Hemangioma from head to toe: MR imaging with pathologic correlation. Radiographics. 24 (2): 367-85. PMID   15026587 doi : 10.1148/rg.242035079
  5. Gardiner M, Eisen S, Murphy C. Training in paediatrics: the essential curriculum. Oxford University Press, Oxford 2009.
  6. 1 2 David C Wolf (2017-10-17). "Hepatic Hemangiomas Treatment & Management".
  7. Gedaly, Roberto; Pomposelli, J. J.; Pomfret, E. A.; Lewis, W. D.; Jenkins, R. L. (1999). "Cavernous Hemangioma of the Liver". Archives of Surgery. 134 (4): 407–411. doi:10.1001/archsurg.134.4.407. PMID   10199314. S2CID   22413827.
  8. Singh, R. K.; Kapoor, S.; Sahni, P.; Chattopadhyay, T. K. (2007). "Giant Haemangioma of the Liver: Is Enucleation Better than Resection?". Annals of the Royal College of Surgeons of England. 89 (5): 490–493. doi:10.1308/003588407X202038. PMC   2048596 . PMID   17688721.