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. 2010 Dec 27;2(12):428-33.
doi: 10.4254/wjh.v2.i12.428.

Spontaneous rupture of hepatic hemangiomas: A review of the literature

Marcelo Af Ribeiro Jr  1 , Francine Papaiordanou, Juliana M Gonçalves, Eleazar Chaib
Affiliations

Spontaneous rupture of hepatic hemangiomas: A review of the literature

Marcelo Af Ribeiro Jr et al. World J Hepatol. .

Abstract

Hepatic hemangiomas are congenital vascular malformations, considered the most common benign mesenchymal hepatic tumors, composed of masses of blood vessels that are atypical or irregular in arrangement and size. Hepatic hemangiomas can be divided into two major groups: capillary hemangiomas and cavernous hemangiomas These tumors most frequently affect females (80%) and adults in their fourth and fifth decades of life. Most cases are asymptomatic although a few patients may present with a wide variety of clinical symptoms, with spontaneous or traumatic rupture being the most severe complication. In cases of spontaneous rupture, clinical manifestations consist of sudden abdominal pain, and anemia secondary to a haemoperitoneum. Disseminated intravascular coagulopathy can also occur. Haemodynamic instability and signs of hypovolemic shock appear in about one third of cases. As the size of the hemangioma increases, so does the chance of rupture. Imaging studies used in the diagnosis of hepatic hemangiomas include ultrasonography, dynamic contrast-enchanced computed tomography scanning, magnetic resonance imaging, hepatic arteriography, digital subtraction angiography, and nuclear medicine studies. In most cases hepatic hemangiomas are asymptomatic and should be followed up by means of periodic radiological examination. Surgery should be restricted to specific situations. Absolute indications for surgery are spontaneous or traumatic rupture with hemoperitoneum, intratumoral bleeding and consumptive coagulopathy (Kassabach-Merrit syndrome). In a patient presenting with acute abdominal pain due to unknown abdominal disease, spontaneous rupture of a hepatic tumor such as a hemangioma should be considered as a rare differential diagnosis.

Keywords: Giant hepatic hemangioma; Hepatic hemangioma; Liver tumor; Spontaneous rupture; Surgery.

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Figures

Figure 1
Figure 1
Computed tomography scan of a huge liver cavernous hemangioma compromising the right liver lobe.
Figure 2
Figure 2
Intraoperative finding of a huge liver cavernous hemangioma compromising the right liver lobe.
Figure 3
Figure 3
Magnetic resonance imaging of hemangioma. A: Right lobe; B: Left lobe.
See this image and copyright information in PMC

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