| Cavernous liver hemangioma | |
|---|---|
 | |
| Hemangioma of the liver as seen on ultrasound | |
| Specialty | Oncology  |
Acavernous liver hemangioma orhepatic hemangioma is abenign tumor of theliver composed of large vascular spaces lined by monolayer hepaticendothelial cells. It is the most common benign liver tumour, and is usually asymptomatic and diagnosed incidentally onradiological imaging or during laparotomy for other intra-abdominal issues. Liver hemangiomas are thought to becongenital in origin with an incidence rate of 0.4 – 7.3% as reported in autopsy series.[1][2]
Several subtypes exist, including the giant hepatic haemangioma (>10cm), which can cause significant complications.
Liver hemangiomas are typicallyhyperechoic onultrasound though may occasionally behypoechoic; ultrasound is not diagnostic.Computed tomography (CT),[3]magnetic resonance imaging (MRI)[4] orsingle-photon emission computed tomography (SPECT) using autologous labelled Red Blood Cells (RBC) with Tc-99m is diagnostic. Biopsy is avoided due to the risk ofhaemorrhage.[citation needed]
Hepatic hemangiomas can occur as part of a clinical syndrome, for exampleKlippel–Trénaunay syndrome,Osler–Weber–Rendu syndrome andVon Hippel–Lindau syndrome.
This large, atypical hemangioma of the liver may present with abdominal pain or fullness due to hemorrhage,thrombosis ormass effect. It may also lead toleft ventricular volume overload andheart failure due to the increase incardiac output which it causes.[5] Further complications areKasabach–Merritt syndrome, a form ofconsumptive coagulopathy due tothrombocytopaenia, and rupture.
A United States practice is to performliver 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]
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 enlarginglesions, profoundthrombocytopenia, or an uncertain diagnosis of a liver mass. Surgery for large masses is performed withenucleation 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.[1]