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{{CMG}};{{AE}}{{NM}}
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==Overview==
==Overview==
==Hepatic hemangioma natural history==
If left untreated, patients with giant hepatic hemangiomas may progress to develop complications. Complications of hepatic hemangioma include spontaneous rupture, [[Shock|acute hemorrhagic shock]], and [[upper abdominal pain]].<ref name="Assy2009">{{cite journal|last1=Assy|first1=Nimer|title=Characteristics of common solid liver lesions and recommendations for diagnostic workup|journal=World Journal of Gastroenterology|volume=15|issue=26|year=2009|pages=3217|issn=1007-9327|doi=10.3748/wjg.15.3217}}</ref><ref name="EhrlRothaug2012">{{cite journal|last1=Ehrl|first1=Denis|last2=Rothaug|first2=Katharina|last3=Herzog|first3=Peter|last4=Hofer|first4=Bernhard|last5=Rau|first5=Horst-Günter|title=“Incidentaloma” of the Liver: Management of a Diagnostic and Therapeutic Dilemma|journal=HPB Surgery|volume=2012|year=2012|pages=1–14|issn=0894-8569|doi=10.1155/2012/891787}}</ref>
Hepatic hemangioma is the most common benign liver tumor and typically remains stable in size.<ref name="MaruyamaIsokawa2013">{{cite journal|last1=Maruyama|first1=Masaki|last2=Isokawa|first2=Osamu|last3=Hoshiyama|first3=Koki|last4=Hoshiyama|first4=Ayako|last5=Hoshiyama|first5=Mari|last6=Hoshiyama|first6=Yoshihiro|title=Diagnosis and Management of Giant Hepatic Hemangioma: The Usefulness of Contrast-Enhanced Ultrasonography|journal=International Journal of Hepatology|volume=2013|year=2013|pages=1–6|issn=2090-3448|doi=10.1155/2013/802180}}</ref>
[[Prognosis]] is generally excellent, and the [[mortality rate]] of patients with spontaneous rupture of hepatic hemangioma is approximately 30-40%.<ref name="EhrlRothaug2012">{{cite journal|last1=Ehrl|first1=Denis|last2=Rothaug|first2=Katharina|last3=Herzog|first3=Peter|last4=Hofer|first4=Bernhard|last5=Rau|first5=Horst-Günter|title=“Incidentaloma” of the Liver: Management of a Diagnostic and Therapeutic Dilemma|journal=HPB Surgery|volume=2012|year=2012|pages=1–14|issn=0894-8569|doi=10.1155/2012/891787}}</ref>
These are usually diagnosed as asymptomatic incidental findings. In addition to nonspecific symptoms, hemangiomas also (rarely) rupture spontaneously or by trauma and then lead to acute hemorrhagic shock with upper abdominal pain [1, 10, 18]. In the worldwide literature a total of only 97 cases with a rupture of a hemangioma have been published, whereas a spontaneous rupture only happened in 47.4% of cases (46) [19]. Further investigation showed that these spontaneously ruptured hemangiomas had a mean size of 11.2 cm [19]. In an acute situation, the immediate restitution of coagulation factors and rarely TAE are methods of choice [1, 10, 11, 18]. TAE teatment of a hemangioma is difficult and due to the aberrant collateral arterial circulation making almost improbable to stop the multiple inflow from different feeding arteries especially through the periphery of the hemangiomas. Despite therapy, in these situations the mortality rate is 30–40%.
==Natural history==
Hemangiomas generally have no growth tendency. In the literature, however, cases of hemangioma growth during pregnancy or after estrogen administration are described [1, 10]. Hemangiomas (10 cm should generally not be treated, even before a pregnancy. In case of a planned pregnancy and a size )10 cm, due to the risk of a possible rupture, a definitive treatment should be discussed [1, 10]. Several studies have concluded that a spontaneous rupture of a hemangioma (even while pregnancy) [10, 19] occurs only very rarely, and therefore a prophylactic resection should only be conducted under special conditions and especially with a size of the hemangioma >11 cm [10]. In case of hemangiomas with high growth trend (>3 cm in 12 months), with symptomatic compression symptoms or recurrent pain, which may correlate with hemorrhage into the lesion, surgical intervention should be indicated [18, 19]. Because of hypotension, unexplained anemia, or diagnosis difficulties of the liver lesion, surgical intervention can be rarely necessary.<ref name="EhrlRothaug2012">{{cite journal|last1=Ehrl|first1=Denis|last2=Rothaug|first2=Katharina|last3=Herzog|first3=Peter|last4=Hofer|first4=Bernhard|last5=Rau|first5=Horst-Günter|title=“Incidentaloma” of the Liver: Management of a Diagnostic and Therapeutic Dilemma|journal=HPB Surgery|volume=2012|year=2012|pages=1–14|issn=0894-8569|doi=10.1155/2012/891787}}</ref>
*Most of the hepatic hemangiomas are characterized by benign uncomplicated course and most lesions are asymptomatic.<ref>{{cite journal|title=Adult hepatic hemangioma: an updated review with focus on the natural course and treatment options|journal=Abdomen|year=2015|issn=23781351|doi=10.14800/abdomen.908}}</ref>
*Hepatic hemangioma is the most common benign liver tumor and typically remains stable in size.<ref name="MaruyamaIsokawa2013">{{cite journal|last1=Maruyama|first1=Masaki|last2=Isokawa|first2=Osamu|last3=Hoshiyama|first3=Koki|last4=Hoshiyama|first4=Ayako|last5=Hoshiyama|first5=Mari|last6=Hoshiyama|first6=Yoshihiro|title=Diagnosis and Management of Giant Hepatic Hemangioma: The Usefulness of Contrast-Enhanced Ultrasonography|journal=International Journal of Hepatology|volume=2013|year=2013|pages=1–6|issn=2090-3448|doi=10.1155/2013/802180}}</ref>
*These are usually diagnosed as asymptomatic incidental findings.
*Hemangiomas also (rarely) rupture spontaneously or by trauma and then lead to [[Shock|acute hemorrhagic shock]] with [[upper abdominal pain]].<ref name="Assy2009">{{cite journal|last1=Assy|first1=Nimer|title=Characteristics of common solid liver lesions and recommendations for diagnostic workup|journal=World Journal of Gastroenterology|volume=15|issue=26|year=2009|pages=3217|issn=1007-9327|doi=10.3748/wjg.15.3217}}</ref><ref name="EhrlRothaug2012">{{cite journal|last1=Ehrl|first1=Denis|last2=Rothaug|first2=Katharina|last3=Herzog|first3=Peter|last4=Hofer|first4=Bernhard|last5=Rau|first5=Horst-Günter|title=“Incidentaloma” of the Liver: Management of a Diagnostic and Therapeutic Dilemma|journal=HPB Surgery|volume=2012|year=2012|pages=1–14|issn=0894-8569|doi=10.1155/2012/891787}}</ref>
*In the worldwide literature a total of only 97 cases with a rupture of a hemangioma have been published, whereas a spontaneous rupture only happened in 47.4% of cases.<ref name="DonatiStavrou2011">{{cite journal|last1=Donati|first1=Marcello|last2=Stavrou|first2=Gregor A.|last3=Donati|first3=Angelo|last4=Oldhafer|first4=Karl J.|title=The risk of spontaneous rupture of liver hemangiomas: a critical review of the literature|journal=Journal of Hepato-Biliary-Pancreatic Sciences|volume=18|issue=6|year=2011|pages=797–805|issn=18686974|doi=10.1007/s00534-011-0420-7}}</ref><ref name="EhrlRothaug2012">{{cite journal|last1=Ehrl|first1=Denis|last2=Rothaug|first2=Katharina|last3=Herzog|first3=Peter|last4=Hofer|first4=Bernhard|last5=Rau|first5=Horst-Günter|title=“Incidentaloma” of the Liver: Management of a Diagnostic and Therapeutic Dilemma|journal=HPB Surgery|volume=2012|year=2012|pages=1–14|issn=0894-8569|doi=10.1155/2012/891787}}</ref>
*Hemangiomas generally have no growth tendency. In the literature, however, cases of hemangioma growth during [[pregnancy]] or after [[estrogen]] administration are described.<ref name="Assy2009">{{cite journal|last1=Assy|first1=Nimer|title=Characteristics of common solid liver lesions and recommendations for diagnostic workup|journal=World Journal of Gastroenterology|volume=15|issue=26|year=2009|pages=3217|issn=1007-9327|doi=10.3748/wjg.15.3217}}</ref><ref name="EhrlRothaug2012">{{cite journal|last1=Ehrl|first1=Denis|last2=Rothaug|first2=Katharina|last3=Herzog|first3=Peter|last4=Hofer|first4=Bernhard|last5=Rau|first5=Horst-Günter|title=“Incidentaloma” of the Liver: Management of a Diagnostic and Therapeutic Dilemma|journal=HPB Surgery|volume=2012|year=2012|pages=1–14|issn=0894-8569|doi=10.1155/2012/891787}}</ref>
*Several studies have concluded that a spontaneous rupture of a hemangioma (even while pregnancy) occurs only very rarely.<ref name="EhrlRothaug2012">{{cite journal|last1=Ehrl|first1=Denis|last2=Rothaug|first2=Katharina|last3=Herzog|first3=Peter|last4=Hofer|first4=Bernhard|last5=Rau|first5=Horst-Günter|title=“Incidentaloma” of the Liver: Management of a Diagnostic and Therapeutic Dilemma|journal=HPB Surgery|volume=2012|year=2012|pages=1–14|issn=0894-8569|doi=10.1155/2012/891787}}</ref>
==Complications==
Complications of hepatic hemangioma include:<ref name="Assy2009">{{cite journal|last1=Assy|first1=Nimer|title=Characteristics of common solid liver lesions and recommendations for diagnostic workup|journal=World Journal of Gastroenterology|volume=15|issue=26|year=2009|pages=3217|issn=1007-9327|doi=10.3748/wjg.15.3217}}</ref><ref name="EhrlRothaug2012">{{cite journal|last1=Ehrl|first1=Denis|last2=Rothaug|first2=Katharina|last3=Herzog|first3=Peter|last4=Hofer|first4=Bernhard|last5=Rau|first5=Horst-Günter|title=“Incidentaloma” of the Liver: Management of a Diagnostic and Therapeutic Dilemma|journal=HPB Surgery|volume=2012|year=2012|pages=1–14|issn=0894-8569|doi=10.1155/2012/891787}}</ref>
*Spontaneous rupture
:*[[Shock|Acute hemorrhagic shock]]
:*[[Upper abdominal pain]]
*[[Pregnancy]] and [[estrogen]]-based medications are associated with hemangioma growth.<ref name="Assy2009">{{cite journal|last1=Assy|first1=Nimer|title=Characteristics of common solid liver lesions and recommendations for diagnostic workup|journal=World Journal of Gastroenterology|volume=15|issue=26|year=2009|pages=3217|issn=1007-9327|doi=10.3748/wjg.15.3217}}</ref><ref name="EhrlRothaug2012">{{cite journal|last1=Ehrl|first1=Denis|last2=Rothaug|first2=Katharina|last3=Herzog|first3=Peter|last4=Hofer|first4=Bernhard|last5=Rau|first5=Horst-Günter|title=“Incidentaloma” of the Liver: Management of a Diagnostic and Therapeutic Dilemma|journal=HPB Surgery|volume=2012|year=2012|pages=1–14|issn=0894-8569|doi=10.1155/2012/891787}}</ref>


==Complications==
In rare cases, a cavernous hemangioma may rupture. Babies may develop a type of hepatic hemangioma called [[benign infantile hemangioendothelioma]] (also called [[multinodular hepatic hemangiomatosis]]). This rare, noncancerous tumor has been linked to high rates of [[heart failure]] and death in infants. Infants are usually diagnosed by the time they are 6 months old.
[[Pregnancy]] and [[estrogen]]-based medications can cause [[cavernous hemangioma]]s to grow.
==Prognosis==
==Prognosis==
 
*The [[case fatality rate]] of patients with spontaneous rupture of hepatic hemangioma is approximately 30-40% despite therapy.<ref name="EhrlRothaug2012">{{cite journal|last1=Ehrl|first1=Denis|last2=Rothaug|first2=Katharina|last3=Herzog|first3=Peter|last4=Hofer|first4=Bernhard|last5=Rau|first5=Horst-Günter|title=“Incidentaloma” of the Liver: Management of a Diagnostic and Therapeutic Dilemma|journal=HPB Surgery|volume=2012|year=2012|pages=1–14|issn=0894-8569|doi=10.1155/2012/891787}}</ref>
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}


Latest revision as of 21:35, 8 December 2015

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Nawal Muazam M.D.[2]

Overview

If left untreated, patients with giant hepatic hemangiomas may progress to develop complications. Complications of hepatic hemangioma include spontaneous rupture, acute hemorrhagic shock, and upper abdominal pain.[1][2] Prognosis is generally excellent, and the mortality rate of patients with spontaneous rupture of hepatic hemangioma is approximately 30-40%.[2]

Natural history

  • Most of the hepatic hemangiomas are characterized by benign uncomplicated course and most lesions are asymptomatic.[3]
  • Hepatic hemangioma is the most common benign liver tumor and typically remains stable in size.[4]
  • These are usually diagnosed as asymptomatic incidental findings.
  • Hemangiomas also (rarely) rupture spontaneously or by trauma and then lead to acute hemorrhagic shock with upper abdominal pain.[1][2]
  • In the worldwide literature a total of only 97 cases with a rupture of a hemangioma have been published, whereas a spontaneous rupture only happened in 47.4% of cases.[5][2]
  • Hemangiomas generally have no growth tendency. In the literature, however, cases of hemangioma growth during pregnancy or after estrogen administration are described.[1][2]
  • Several studies have concluded that a spontaneous rupture of a hemangioma (even while pregnancy) occurs only very rarely.[2]

Complications

Complications of hepatic hemangioma include:[1][2]

  • Spontaneous rupture

Prognosis

  • The case fatality rate of patients with spontaneous rupture of hepatic hemangioma is approximately 30-40% despite therapy.[2]

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 Assy, Nimer (2009). "Characteristics of common solid liver lesions and recommendations for diagnostic workup". World Journal of Gastroenterology. 15 (26): 3217. doi:10.3748/wjg.15.3217. ISSN 1007-9327.
  2. ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 Ehrl, Denis; Rothaug, Katharina; Herzog, Peter; Hofer, Bernhard; Rau, Horst-Günter (2012). ""Incidentaloma" of the Liver: Management of a Diagnostic and Therapeutic Dilemma". HPB Surgery. 2012: 1–14. doi:10.1155/2012/891787. ISSN 0894-8569.
  3. ↑ "Adult hepatic hemangioma: an updated review with focus on the natural course and treatment options". Abdomen. 2015. doi:10.14800/abdomen.908. ISSN 2378-1351.
  4. ↑ Maruyama, Masaki; Isokawa, Osamu; Hoshiyama, Koki; Hoshiyama, Ayako; Hoshiyama, Mari; Hoshiyama, Yoshihiro (2013). "Diagnosis and Management of Giant Hepatic Hemangioma: The Usefulness of Contrast-Enhanced Ultrasonography". International Journal of Hepatology. 2013: 1–6. doi:10.1155/2013/802180. ISSN 2090-3448.
  5. ↑ Donati, Marcello; Stavrou, Gregor A.; Donati, Angelo; Oldhafer, Karl J. (2011). "The risk of spontaneous rupture of liver hemangiomas: a critical review of the literature". Journal of Hepato-Biliary-Pancreatic Sciences. 18 (6): 797–805. doi:10.1007/s00534-011-0420-7. ISSN 1868-6974.
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