Clinical features and management of multifocal hepatic hemangiomas in children: a retrospective study

Abstract

Multifocal hepatic hemangioma (MHH) is a benign hepatic tumor that is commonly diagnosed in children with multiple cutaneous infantile hemangiomas (IHs). We present a review of all children with MHH at our institutions. Of the 42 patients, the median age at presentation of MHH was 2.5 months. Thirty-six (85.7%) patients had cutaneous IHs. Twelve (28.6%) patients were symptomatic at presentation. There was no significant association between the number of hepatic hemangiomas and the number of cutaneous IHs. Fourteen (33.3%) patients received some form of treatment for hepatic hemangiomas. The most common type of treatment was oral prednisone in 8 patients, followed by oral propranolol in 6 patients. Two patients were totally resistant to prednisone treatment. They died from congestive heart failure or respiratory distress and coagulopathy. Two patients with problematic facial IH were treated with intralesional triamcinolone injection. The remaining 26 patients were managed with imaging surveillance. On follow-up, all of the survivors had a favorable outcome. Our study suggests that the clinical features of MHH are variable. Our data emphasize the treatment strategy that aggressive treatment is indicated in symptomatic or progressive MHHs, whereas observation management of asymptomatic patients with a few small lesions is safe and appropriate.

Figure 1. Multiple cutaneous IHs associated with MHHs in a 1-month-old girl.

(A) Multiple IHs on the face and trunk. This patient also had additional lesions on the extremities. (B) T2-weighted axial MRI of the liver showed lesions were hyperintense with intervening areas of normal hepatic parenchyma.

Figure 2. MHH in a 4.5-month-old boy (Patient #2 in Table 2).

(A) An axial unenhanced CT scan showed multiple hypodense hepatic masses ranging from 1.0 to 4.0 in diameter. (B) An axial enhanced CT scan showed an enhancement of the liver masses. Some of the masses showed confluence.

Figure 3. Propranolol treatment for multifocal IH in a 1.5-month-old boy (Patient #11 in Table 2).

Clinical photographs of cutaneous IHs, 1 day before propranolol treatment (A) and 6 months after the start of treatment (B). T2-weighted axial MRI showed MHH, 1 day before propranolol treatment (C) and 6 months after the start of treatment (D).