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. 2022 Sep;26(9):1998-2007.
doi: 10.1007/s11605-022-05382-1. Epub 2022 Jun 15.

A Comprehensive Review of Hepatic Hemangioma Management

Hassan Aziz  1 , Zachary J Brown  2 , Azarakhsh Baghdadi  3 , Ihab R Kamel  3 , Timothy M Pawlik  4
Affiliations

A Comprehensive Review of Hepatic Hemangioma Management

Hassan Aziz et al. J Gastrointest Surg. 2022 Sep.

Abstract

Background: Hepatic hemangiomas (HHs) are benign liver lesions often discovered incidentally on imaging for various unrelated pathologies. We herein review the etiology, classification, diagnostic imaging, and management of HHs.

Methods: A comprehensive systematic review was performed utilizing MEDLINE/PubMed and Web of Science databases, with the end of search date being March 1, 2022, regarding HH diagnosis, imaging, and management.

Results: HHs can be broadly classified as capillary hemangiomas or cavernous hemangiomas. While the exact pathophysiology related to the development of HHs remains largely unknown, hormone exposure has been postulated to cause HH growth. HHs appear homogenously hyperechoic on US with distinct margins and posterior acoustic enhancement. While cavernous hemangiomas appear as well-defined hypodense lesions on pre-contrast CT images with the same density as the vasculature, one of the most reliable imaging features for diagnosing cavernous hemangiomas is high signal intensity on T2 weighted images. While most HHs are asymptomatic, some patients can present with pain or compressive symptoms with bleeding/rupture being very rare. Kasabach-Merritt syndrome is a rare but life-threatening condition associated with thrombocytopenia and microangiopathic hemolytic anemia. When HHs are symptomatic or in the setting of Kasabach Merritt syndrome, surgery is indicated. Enucleation is an attractive surgical option for HH as it spares normal liver tissue. Most patients experience symptom relief following surgical resection.

Conclusion: HHs are very common benign liver lesions. High-quality imaging is imperative to distinguish HHs from other liver lesions. Surgery is generally reserved for patients who present with symptoms such as pain, obstruction, or rarely Kasabach-Merritt syndrome. Surgery can involve either formal resection or, in most instances, simple enucleation. Patients generally have good outcomes following surgery with resolution of their symptoms.

Keywords: Hemangioma; Liver; Resection; Surgery.

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References

    1. Leon M, Chavez L, Surani S. Hepatic hemangioma: What internists need to know. World journal of gastroenterology. 2020;26(1):11-20. - PubMed - PMC - DOI
    1. Bajenaru N, Balaban V, Săvulescu F, Campeanu I, Patrascu T. Hepatic hemangioma -review. J Med Life. 2015;8 Spec Issue(Spec Issue):4-11. - PubMed
    1. Belghiti J, Cauchy F, Paradis V, Vilgrain V. Diagnosis and management of solid benign liver lesions. Nature reviews Gastroenterology & hepatology. 2014;11(12):737-749. - DOI
    1. Roebuck D, Sebire N, Lehmann E, Barnacle A. Rapidly involuting congenital haemangioma (RICH) of the liver. Pediatr Radiol. 2012;42(3):308-314. - PubMed - DOI
    1. Glinkova V, Shevah O, Boaz M, Levine A, Shirin H. Hepatic haemangiomas: possible association with female sex hormones. Gut. 2004;53(9):1352-1355. - PubMed - PMC - DOI

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