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Hepatic hemangioma

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun M.D., PhD., Nawal Muazam M.D.[2]

Synonyms and keywords: Liver hemangioma; Hemangioma of the liver; Cavernous hepatic hemangioma; Typical hepatic hemangioma; Atypical hepatic hemangioma; Giant hepatic hemangioma; Flash filling hepatic hemangioma; Slow fill hepatic hemangioma; Calcified hepatic hemangioma; Hyalinised hepatic hemangioma; Sclerosed hepatic hemangioma; Pedunculated hepatic hemangioma; Cystic hepatic hemangioma; Hepatocyte hemangioma; Hepatocellular hemangioma

Overview

Overview

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Nawal Muazam M.D.[2]

Overview

Hepatic hemangioma is a noncancerous liver tumor made of dilated (widened) blood vessels. It is the most common primary liver tumor. The first case of spontaneous rupture of a hepatic hemangioma was described by Van Haefen in 1898.[1] Hepatic hemangioma may be classified into typical and atypical hemangioma.[1][2] Development of hepatic hemangioma is the result of genetic mutations, overexpression of angiogenic fators and downregulation of inhibitors of angiogenesis.[3] Hepatic hemangioma may be associated with Kasabach-Merritt syndrome, hereditary hemorrhagic telangiectasia, hepatic arterio-portal shunts, extra hepatic hemangiomata, hemolytic anemia, focal nodular hyperplasia.[4] On gross pathology, a well-circumscribed subcapsular tumor may be suggestive of hepatic hemangioma.[5] Hepatic hemangioma must be differentiated from other diseases such as hepatic abscess, hepatocellular carcinoma, hepatic cyst, and hemangioendothelioma.[2] The prevalence of hepatic hemangioma is estimated to be up to 20% in general population.[6] Hepatic hemangioma commonly affects individuals between 30 to 50 years of age.[6] If left untreated, patients with giant hepatic hemangiomas may progress to develop complications. Complications of hepatic hemangioma include spontaneous rupture, acute hemorrhagic shock, and upper abdominal pain.[7][8] Prognosis is generally excellent, and the mortality rate of patients with spontaneous rupture of hepatic hemangioma is approximately 30-40%.[8] Symptoms of hepatic hemangioma include intermittent right upper quadrant abdominal pain, dyspepsia, early satiety, and vomiting.[9][10] Common physical examination findings of hepatic hemangioma include palpable upper abdominal mass, hepatomegaly, and biliary colic.[10][11] Some patients with hepatic hemangioma may have elevated concentration of transaminases, bilirubin, and alkaline phosphatase even in asymptomatic cases.[9] On CT scan, hepatic hemangioma is characterized by dynamic enhancement pattern related to the size of its vascular space.[2] Observation is recommended for patients with small hemangiomas (less than 4 cm), whereas asymptomatic patients are followed up with periodic radiological examination.[1][2] Elective surgical resection is recommended among all symptomatic patients with large hepatic hemangioma > 5 cm.[12]

Historical Perspective

The first case of spontaneous rupture of a hepatic hemangioma was described by Van Haefen in 1898.[1]

Classification

Hepatic hemangioma may be classified into typical and atypical hemangioma.[1][2]

Pathophysiology

Development of hepatic hemangioma is the result of genetic mutations, overexpression of angiogenic fators and downregulation of inhibitors of angiogenesis.[3] Hepatic hemangioma may be associated with Kasabach-Merritt syndrome, hereditary hemorrhagic telangiectasia, hepatic arterio-portal shunts, extra hepatic hemangiomata, hemolytic anemia, focal nodular hyperplasia.[4] On gross pathology, a well-circumscribed, subcapsular tumor may be suggestive of hepatic hemangioma.[5] On microscopic histopathological analysis channels lined by benign endothelium containing RBCs, surrounding (non-endothelial) cells without significant atypia are findings of hepatic hemangioma.[13]

Causes

There are no established causes for hepatic hemangioma.[1]

Differentiating Hepatic hemangioma from other Diseases

Hepatic hemangioma must be differentiated from other diseases such as hepatic abscess, hepatocellular carcinoma, hepatic cyst, and hemangioendothelioma.[2]

Epidemiology and Demographics

The prevalence of hepatic hemangioma is estimated to be up to 20% in general population.[6] Hepatic hemangioma commonly affects individuals between 30 to 50 years of age.[6] Females are more commonly affected with hepatic hemangioma than males. The female to male ratio is 3:1.[6]

Risk Factors

Common risk factors in the development of hepatic hemangioma are age, female gender, oral contraceptive pills, and pregnancy.[10]

Screening

According to the American Association for the Study of Liver Diseases and United States Preventive Services Task Force, there is insufficient evidence to recommend routine screening for hepatic hemangioma.[14][15]

Natural History, Complications and Prognosis

If left untreated, patients with giant hepatic hemangiomas may progress to develop complications. Complications of hepatic hemangioma include spontaneous rupture, acute hemorrhagic shock, and upper abdominal pain.[7][8] Prognosis is generally excellent, and the mortality rate of patients with spontaneous rupture of hepatic hemangioma is approximately 30-40%.[8]

Diagnosis

History and symptoms

Symptoms of hepatic hemangioma include intermittent right upper quadrant abdominal pain, dyspepsia, early satiety, and vomiting.[9][10]

Physical Examination

Common physical examination findings of hepatic hemangioma include palpable upper abdominal mass, hepatomegaly, and biliary colic.[10][11]

Laboratory Findings

Some patients with hepatic hemangioma may have elevated concentration of transaminases, bilirubin, and alkaline phosphatase even in asymptomatic cases.[9]

CT

On CT scan, hepatic hemangioma is characterized by dynamic enhancement pattern related to the size of its vascular space.[2]

MRI

On MRI, hepatic hemangioma is characterized by hypointensity on T1-weighted imaging and hyperintensity on T2-weighted imaging.[2]

Ultrasound

On liver ultrasound, hepatic hemangioma is characterized by well-defined hyperechoic lesions.[2]

Other Imaging Findings

Other imaging finding for hepatic hemangioma include SPECT, which demonstrates decreased activity on initial dynamic images and increased activity on delayed, blood pool images.[2]

Other Diagnostic Studies

Other diagnostic studies for hepatic hemangioma include biopsy, which should be avoided due to risk of bleeding.[10]

Treatment

Medical therapy

Observation is recommended for patients with small hemangiomas (less than 4 cm), whereas asymptomatic patients are followed up with periodic radiological examination.[1][2]

Surgery

Elective surgical resection is recommended among symptomatic patients with large hepatic hemangioma > 5 cm.[12]

Prevention

There are no primary or secondary preventive measures available for hepatic hemangioma.[10]

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 Jr, Marcelo AF Ribeiro (2010). “Spontaneous rupture of hepatic hemangiomas: A review of the literature”. World Journal of Hepatology. 2 (12): 428. doi:10.4254/wjh.v2.i12.428. ISSN 1948-5182.
  2. ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 Subtypes of hepatic hemangioma. Dr Yuranga Weerakkody et al. Radiopaedia 2015. http://radiopaedia.org/articles/hepatic-haemangioma-3. Accessed on October 26, 2015
  3. ↑ 3.0 3.1 Papafragkakis, Haris; Moehlen, Martin; Garcia-Buitrago, Monica T.; Madrazo, Beatrice; Island, Eddie; Martin, Paul (2011). “A Case of a Ruptured Sclerosing Liver Hemangioma”. International Journal of Hepatology. 2011: 1–5. doi:10.4061/2011/942360. ISSN 2090-3456.
  4. ↑ 4.0 4.1 Associations of hepatic hemangioma. Dr Yuranga Weerakkody et al. Radiopaedia (2015). http://radiopaedia.org/articles/hepatic-haemangioma-3. Accessed on November 7, 2015
  5. ↑ 5.0 5.1 Gross pathology of hepatic hemangioma. Librepathology 2015. http://librepathology.org/wiki/index.php/Hemangioma_of_the_liver. Accessed on October 20, 2015
  6. ↑ 6.0 6.1 6.2 6.3 6.4 “Adult hepatic hemangioma: an updated review with focus on the natural course and treatment options”. Abdomen. 2015. doi:10.14800/abdomen.908. ISSN 2378-1351.
  7. ↑ 7.0 7.1 Assy, Nimer (2009). “Characteristics of common solid liver lesions and recommendations for diagnostic workup”. World Journal of Gastroenterology. 15 (26): 3217. doi:10.3748/wjg.15.3217. ISSN 1007-9327.
  8. ↑ 8.0 8.1 8.2 8.3 Ehrl, Denis; Rothaug, Katharina; Herzog, Peter; Hofer, Bernhard; Rau, Horst-Günter (2012). ““Incidentaloma” of the Liver: Management of a Diagnostic and Therapeutic Dilemma”. HPB Surgery. 2012: 1–14. doi:10.1155/2012/891787. ISSN 0894-8569.
  9. ↑ 9.0 9.1 9.2 9.3 Jr MA, Papaiordanou F, Gonçalves JM, Chaib E (2010). “Spontaneous rupture of hepatic hemangiomas: A review of the literature”. World J Hepatol. 2 (12): 428–33. doi:10.4254/wjh.v2.i12.428. PMC 3010512. PMID 21191518.
  10. ↑ 10.0 10.1 10.2 10.3 10.4 10.5 10.6 Marrero, Jorge A; Ahn, Joseph; Rajender Reddy, K (2014). “ACG Clinical Guideline: The Diagnosis and Management of Focal Liver Lesions”. The American Journal of Gastroenterology. 109 (9): 1328–1347. doi:10.1038/ajg.2014.213. ISSN 0002-9270.
  11. ↑ 11.0 11.1 “Adult hepatic hemangioma: an updated review with focus on the natural course and treatment options”. Abdomen. 2015. doi:10.14800/abdomen.908. ISSN 2378-1351.
  12. ↑ 12.0 12.1 Erdogan D, Busch OR, van Delden OM, Bennink RJ, ten Kate FJ, Gouma DJ; et al. (2007). “Management of liver hemangiomas according to size and symptoms”. J Gastroenterol Hepatol. 22 (11): 1953–8. doi:10.1111/j.1440-1746.2006.04794.x. PMID 17914976.
  13. ↑ Microscopic features of hepatic hemangioma. Librepathology 2015. http://librepathology.org/wiki/index.php/Hemangioma_of_the_liver. Accessed on October 20, 2015
  14. ↑ Hepatic hemangioma. USPSTF. http://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=hepatic+hemangioma Accessed on October 20, 2015
  15. ↑ Hepatic hemangioma. AASLD. https://www.aasld.org/search/node/hepatic%20hemangioma Accessed on October 20, 2015
Historical perspective

Historical perspective

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Nawal Muazam M.D.[2]

Overview

The first case of spontaneous rupture of a hepatic hemangioma was described by Van Haefen in 1898.[1]

Historical Perspective

The first case of spontaneous rupture of a hepatic hemangioma was described by Van Haefen in 1898.[1]

References

  1. ↑ 1.0 1.1 Jr, Marcelo AF Ribeiro (2010). “Spontaneous rupture of hepatic hemangiomas: A review of the literature”. World Journal of Hepatology. 2 (12): 428. doi:10.4254/wjh.v2.i12.428. ISSN 1948-5182.
Classification

Classification

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Nawal Muazam M.D.[2]

Overview

Hepatic hemangioma may be classified into typical and atypical hemangioma.[1][2]

Classification

Hepatic hemangioma may be classified into:[1][2]

References

  1. ↑ 1.0 1.1 Jr, Marcelo AF Ribeiro (2010). “Spontaneous rupture of hepatic hemangiomas: A review of the literature”. World Journal of Hepatology. 2 (12): 428. doi:10.4254/wjh.v2.i12.428. ISSN 1948-5182.
  2. ↑ 2.0 2.1 Subtypes of hepatic hemangioma. Dr Yuranga Weerakkody et al. Radiopaedia 2015. http://radiopaedia.org/articles/hepatic-haemangioma-3. Accessed on October 26, 2015
Pathophysiology

Pathophysiology

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Nawal Muazam M.D.[2]

Overview

Development of hepatic hemangioma is the result of genetic mutations, overexpression of angiogenic fators and downregulation of inhibitors of angiogenesis.[1] Hepatic hemangioma may be associated with Kasabach-Merritt syndrome, hereditary hemorrhagic telangiectasia, hepatic arterio-portal shunts, extra hepatic hemangiomata, hemolytic anemia, focal nodular hyperplasia.[2] On gross pathology, variable in size, well circumscribed, and classically subcapsular are findings of hepatic hemangioma.[3] On microscopic histopathological analysis channels lined by benign endothelium containing RBCs, surrounding (non-endothelial) cells without significant atypia are findings of hepatic hemangioma.[4]

Pathophysiology

Pathogenesis

The pathogenesis of hepatic hemangiomas has not been elucidated, but there are two competing theories.

First theory

  • The first theory supports the notion that hepatic hemangioma may be the result of overexpression of angiogenic factors and downregulation of inhibitors of angiogenesis.
  • Overexpression of angiographic factors, such as:[1]
  • Downregulation of inhibitors of angiogenesis, such as:[1]

Second theory

  • The second theory suggests that the presence of liver hemangiomas involves a genetic background of mutations.[1]
  • Metalloproteinases accumulate in the endoplasmic reticulum of the tumor cells. Accumulation may result in the following:
  • Self-digestion
  • Vacuole formation
  • Cavernous hemangioma cell to downregulate Derlin-1.
  • Derlin-1 is a protein encoded by DERL1. When overexpressed, derlin-1 protein induces the dilated endoplasmic reticulum to return to its normal size.

Associated Conditions

Hepatic hemangioma may be associated with:[2]

Gross Pathology

On gross pathology, a well circumscribed, subcapsular tumor may be suggestive of hepatic hemangioma.[3]

Microscopic Pathology

On microscopic histopathological analysis channels lined by benign endothelium containing RBCs, surrounding (non-endothelial) cells without significant atypia are findings of hepatic hemangioma.[4]

  • Intermediate magnification micrograph of a cavernous hemangioma of the liver, also hepatic cavernous hemangioma, liver hemangioma,cavernous liver hemangioma. H&E stain. No liver tissue is observed.[4]
    Intermediate magnification micrograph of a cavernous hemangioma of the liver, also hepatic cavernous hemangioma, liver hemangioma,cavernous liver hemangioma. H&E stain. No liver tissue is observed.[4]
  • High magnification micrograph of a cavernous hemangioma of the liver, also hepatic cavernous hemangioma, liver hemangioma,cavernous liver hemangioma. H&E stain. No liver tissue is observed.[4]
    High magnification micrograph of a cavernous hemangioma of the liver, also hepatic cavernous hemangioma, liver hemangioma,cavernous liver hemangioma. H&E stain. No liver tissue is observed.[4]

References

  1. ↑ 1.0 1.1 1.2 1.3 Papafragkakis, Haris; Moehlen, Martin; Garcia-Buitrago, Monica T.; Madrazo, Beatrice; Island, Eddie; Martin, Paul (2011). “A Case of a Ruptured Sclerosing Liver Hemangioma”. International Journal of Hepatology. 2011: 1–5. doi:10.4061/2011/942360. ISSN 2090-3456.
  2. ↑ 2.0 2.1 Associations of hepatic hemangioma. Dr Yuranga Weerakkody et al. Radiopaedia (2015). http://radiopaedia.org/articles/hepatic-haemangioma-3. Accessed on November 7, 2015
  3. ↑ 3.0 3.1 Gross pathology of hepatic hemangioma. Librepathology 2015. http://librepathology.org/wiki/index.php/Hemangioma_of_the_liver. Accessed on October 20, 2015
  4. ↑ 4.0 4.1 4.2 4.3 Microscopic features of hepatic hemangioma. Librepathology 2015. http://librepathology.org/wiki/index.php/Hemangioma_of_the_liver. Accessed on October 20, 2015
Causes

Causes

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Nawal Muazam M.D.[2]

Overview

There are no established causes for hepatic hemangioma.[1]

Hepatic hemangioma causes

There are no established causes for hepatic hemangioma.[1]

References

  1. ↑ 1.0 1.1 Jr, Marcelo AF Ribeiro (2010). “Spontaneous rupture of hepatic hemangiomas: A review of the literature”. World Journal of Hepatology. 2 (12): 428. doi:10.4254/wjh.v2.i12.428. ISSN 1948-5182.
Differentiating Hepatic Hemangioma from other Diseases

Differentiating Hepatic Hemangioma from other Diseases

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Nawal Muazam M.D.[2]

Overview

Hepatic hemangioma must be differentiated from other diseases such as hepatic abscess, hepatocellular carcinoma, hepatic cyst, and hemangioendothelioma.[1]

Hepatic hemangioma differential diagnosis

Hepatic hemangioma must be differentiated from other diseases such as:[1]

  • Hepatic metastases
  • Hypervascular hepatic metastases show marked early enhancement with a continuous ring
  • That on later images fills in centrally
  • Progressive centripetal fill-in may occur on delayed phases

Differentiating Hepatic hemangioma from other causes of jaundice and abdominal pain

Hepatic hemangioma must be differentiated from other diseases that cause jaundice, abdominal pain, weight loss, and fever such as Gallbladder cancer, hepatocellular carcinoma, pancreatic cancer, cholecystitis, choledochitis and liver fluke infections.


Abbreviations: RUQ= Right upper quadrant of the abdomen, LUQ= Left upper quadrant, LLQ= Left lower quadrant, RLQ= Right lower quadrant, LFT= Liver function test, SIRS= Systemic inflammatory response syndrome, ERCP= Endoscopic retrograde cholangiopancreatography, IV= Intravenous, N= Normal, AMA= Anti mitochondrial antibodies, LDH= Lactate dehydrogenase, GI= Gastrointestinal, CXR= Chest X ray, IgA= Immunoglobulin A, IgG= Immunoglobulin G, IgM= Immunoglobulin M, CT= Computed tomography, PMN= Polymorphonuclear cells, ESR= Erythrocyte sedimentation rate, CRP= C-reactive protein, TS= Transferrin saturation, SF= Serum Ferritin, SMA= Superior mesenteric artery, SMV= Superior mesenteric vein, ECG= Electrocardiogram

Disease Clinical manifestations Diagnosis Comments
Symptoms Signs
Abdominal Pain Fever Rigors and chills Nausea or vomiting Jaundice Constipation Diarrhea Weight loss GI bleeding Hypo-

tension

Guarding Rebound Tenderness Bowel sounds Lab Findings Imaging
Cholangiocarcinoma RUQ + − + + − − + − − − + Normal
  • Predisposes to pancreatic cancer
Hepatocellular carcinoma/Metastasis RUQ + − + + + + + + + − +
  • Normal
  • Hyperactive if obstruction present

Other symptoms:

Pancreatic carcinoma MidEpigastric − − + + + − + − − − + Normal

Skin manifestations may include:

Focal nodular hyperplasia Diffuse ± − − ± − − + + − − − Normal
  • Open biopsy if diagnosis can not be established
Disease Abdominal Pain Fever Rigors and chills Nausea or vomiting Jaundice Constipation Diarrhea Weight loss GI bleeding Hypo-

tension

Guarding Rebound Tenderness Bowel sounds Lab Findings Imaging Comments
Gallbladder cancer Midepigastric − − + + − + + − − − − Normal
Liver hemangioma Intermittent RUQ − − + + − − − − − − − Normal
  • Abnormal LFTs
Liver abscess RUQ + − + + − − + − − − − Normal
  • US
  • CT
Cirrhosis RUQ+Bloating + − + + − − + − − − − Normal US
  • Stigmata of liver disease
  • Cruveilhier- Baumgarten murmur
Inflammatory lesions RUQ ± − + + − − − − − − − Normal US
  • Nodular,shrunken or coarse liver
  • Stigmata of liver disease

References

  1. ↑ 1.0 1.1 Differential diagnosis of hepatic hemangioma. Dr Yuranga Weerakkody et al. Radiopaedia (2015). http://radiopaedia.org/articles/hepatic-haemangioma-3. Accessed on October 26, 2015
Epidemiology and Demographics

Epidemiology and Demographics

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Nawal Muazam M.D.[2]

Overview

The prevalence of hepatic hemangioma is estimated to be upto 20% in general population.[1] Hepatic hemangioma commonly affects individuals between 30 to 50 years of age.[1] Females are more commonly affected with hepatic hemangioma than males. The female to male ratio is 3:1.[1]

Epidemiology and Demographics

Prevalence

The prevalence of hepatic hemangioma is estimated to be up to 20% in general population.[1]

Age

Hepatic hemangioma can occur at any time, but commonly affects individuals between 30 to 50 years of age.[1]

Gender

Females are more commonly affected with hepatic hemangioma than males. The female to male ratio is 3:1.[1]

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 “Adult hepatic hemangioma: an updated review with focus on the natural course and treatment options”. Abdomen. 2015. doi:10.14800/abdomen.908. ISSN 2378-1351.
Risk Factors

Risk Factors

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Nawal Muazam M.D.[2]

Overview

Common risk factors in the development of hepatic hemangioma are age, female gender, oral contraceptive pills, and pregnancy.[1]

Hepatic hemangioma risk factors

Common risk factors in the development of hepatic hemangioma are:[1]

  • Age
  • Female gender
  • Oral contraceptive pills
  • Estrogen based medication
  • Pregnancy

References

  1. ↑ 1.0 1.1 Marrero, Jorge A; Ahn, Joseph; Rajender Reddy, K (2014). “ACG Clinical Guideline: The Diagnosis and Management of Focal Liver Lesions”. The American Journal of Gastroenterology. 109 (9): 1328–1347. doi:10.1038/ajg.2014.213. ISSN 0002-9270.
Screening

Screening

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Nawal Muazam M.D.[2]

Overview

According to the American Association for the Study of Liver Diseases and United States Preventive Services Task Force, there is insufficient evidence to recommend routine screening for hepatic hemangioma.[1][2]

Hepatic hemangioma screening

According to the American Association for the Study of Liver Diseases and United States Preventive Services Task Force, there is insufficient evidence to recommend routine screening for hepatic hemangioma.[1][2]

References

  1. ↑ 1.0 1.1 Hepatic hemangioma. USPSTF. http://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=hepatic+hemangioma Accessed on October 20, 2015
  2. ↑ 2.0 2.1 Hepatic hemangioma. AASLD. https://www.aasld.org/search/node/hepatic%20hemangioma Accessed on October 20, 2015


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Natural History, Complications and Prognosis

Natural History, Complications and Prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Nawal Muazam M.D.[2]

Overview

If left untreated, patients with giant hepatic hemangiomas may progress to develop complications. Complications of hepatic hemangioma include spontaneous rupture, acute hemorrhagic shock, and upper abdominal pain.[1][2] Prognosis is generally excellent, and the mortality rate of patients with spontaneous rupture of hepatic hemangioma is approximately 30-40%.[2]

Natural history

  • Most of the hepatic hemangiomas are characterized by benign uncomplicated course and most lesions are asymptomatic.[3]
  • Hepatic hemangioma is the most common benign liver tumor and typically remains stable in size.[4]
  • These are usually diagnosed as asymptomatic incidental findings.
  • Hemangiomas also (rarely) rupture spontaneously or by trauma and then lead to acute hemorrhagic shock with upper abdominal pain.[1][2]
  • In the worldwide literature a total of only 97 cases with a rupture of a hemangioma have been published, whereas a spontaneous rupture only happened in 47.4% of cases.[5][2]
  • Hemangiomas generally have no growth tendency. In the literature, however, cases of hemangioma growth during pregnancy or after estrogen administration are described.[1][2]
  • Several studies have concluded that a spontaneous rupture of a hemangioma (even while pregnancy) occurs only very rarely.[2]

Complications

Complications of hepatic hemangioma include:[1][2]

  • Spontaneous rupture

Prognosis

  • The case fatality rate of patients with spontaneous rupture of hepatic hemangioma is approximately 30-40% despite therapy.[2]

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 Assy, Nimer (2009). “Characteristics of common solid liver lesions and recommendations for diagnostic workup”. World Journal of Gastroenterology. 15 (26): 3217. doi:10.3748/wjg.15.3217. ISSN 1007-9327.
  2. ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 Ehrl, Denis; Rothaug, Katharina; Herzog, Peter; Hofer, Bernhard; Rau, Horst-Günter (2012). ““Incidentaloma” of the Liver: Management of a Diagnostic and Therapeutic Dilemma”. HPB Surgery. 2012: 1–14. doi:10.1155/2012/891787. ISSN 0894-8569.
  3. ↑ “Adult hepatic hemangioma: an updated review with focus on the natural course and treatment options”. Abdomen. 2015. doi:10.14800/abdomen.908. ISSN 2378-1351.
  4. ↑ Maruyama, Masaki; Isokawa, Osamu; Hoshiyama, Koki; Hoshiyama, Ayako; Hoshiyama, Mari; Hoshiyama, Yoshihiro (2013). “Diagnosis and Management of Giant Hepatic Hemangioma: The Usefulness of Contrast-Enhanced Ultrasonography”. International Journal of Hepatology. 2013: 1–6. doi:10.1155/2013/802180. ISSN 2090-3448.
  5. ↑ Donati, Marcello; Stavrou, Gregor A.; Donati, Angelo; Oldhafer, Karl J. (2011). “The risk of spontaneous rupture of liver hemangiomas: a critical review of the literature”. Journal of Hepato-Biliary-Pancreatic Sciences. 18 (6): 797–805. doi:10.1007/s00534-011-0420-7. ISSN 1868-6974.
Diagnosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | CT | MRI | Echocardiography or Ultrasound | Other Imaging Findings | Other Diagnostic Studies

Treatment

Treatment

Medical Therapy | Surgery | Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case Studies

Case #1

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