Hepatic Hemangiomas Quiz

Hepatic Hemangioma: Pathogenesis, Presentation, Imaging, and Management

• Hepatic hemangiomas are the most common benign liver lesion, occurring in 5% to 20% of the population.
• Hemangiomas are congenital malformations comprising blood-filled cavernous spaces lined by a single layer of endothelial cells and separated by fibrous tissue.
• Hemangiomas are well-encapsulated and have no potential for malignant transformation.
• Most patients present with a single lesion, though up to 10% of patients may present with multifocal disease throughout the liver.
• Hemangiomas are small, ranging from several millimeters to several centimeters in diameter, although in rare cases lesions may be greater than 10 cm, which are referred to as giant hemangiomas.
• Hemangiomas are rarely symptomatic, and the majority of cases are incidentally diagnosed during abdominal imaging for other indications.
• Imaging modalities such as ultrasound, CT, and MRI can be used to diagnose hemangiomas based on characteristic appearance.
• Indications for surgical resection include significant growth, significant symptoms that are unresponsive to analgesics and interfere with daily living, or, in exceedingly rare cases, rupture and hemorrhage.
• Unexplained abdominal pains are common in patients with hemangiomas, and it is important to carefully exclude other causes of abdominal pain before ascribing the pain to a known hemangioma.
• Resection can be completed by either open or minimally invasive approaches and involves tumor enucleation, wedge resection, or a formal segmental resection based on the size and location of the lesion in proximity to major biliary and vascular structures.
• For large hemangiomas, preoperative hepatic arterial embolization has been used to mitigate intraoperative bleeding, though this is rarely necessary.
• Orthotopic liver transplant has been used for large, unresectable lesions with good success, but there are currently no effective medical therapies for hemangiomas.