Rapidly involuting congenital haemangioma of the liver

Abstract

Rapidly involuting congenital haemangiomas (RICHs) are rare benign vascular tumours of infancy. They are generally asymptomatic, but can present with thrombocytopaenia and coagulopathy. Significant complications including life-threatening bleeding, high-output heart failure and liver failure, though rare, can occur. RICHs generally regress by 12-14 months of age and can be managed clinically with symptomatic treatment, watchful waiting and close monitoring of the size of the haemangioma. Medical management (corticosteroids, propranolol) has not shown to be effective, in contrast to infantile haemangioma which will not regress spontaneously and has been noted to respond to medical therapy. Awareness of this diagnosis is important to prevent unnecessary medical and surgical intervention. Here, we present a case of a full-term infant with RICH who presented with thrombocytopaenia and abnormal coagulation profile. The coagulopathy was treated symptomatically, while the lesion was observed with serial ultrasounds and gradually decreased in size.

Keywords: hemangioma; neonatal intensive care.

Figure 1

Abdominal ultrasound showing 5.4×3.6×5.0 cm, large, heterogeneous, complex solid mass replacing lateral segment of left hepatic lobe.

Figure 2

Left: Abdominal MRI demonstrating a heterogeneous mass displacing the left pole of the liver. Right: T1-weighted image immediately postintravenous gadolinium administration demonstrates peripheral puddling of contrast material within the lesion (arrows).