cavernous liver haemangioma
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A cavernous liver hemangioma or hepatic hemangioma is a
benign tumor A benign tumor is a mass of cells ( tumor) that does not invade neighboring tissue or metastasize (spread throughout the body). Compared to malignant (cancerous) tumors, benign tumors generally have a slower growth rate. Benign tumors have r ...
of the
liver The liver is a major organ only found in vertebrates which performs many essential biological functions such as detoxification of the organism, and the synthesis of proteins and biochemicals necessary for digestion and growth. In humans, it i ...
composed of hepatic
endothelial The endothelium is a single layer of squamous endothelial cells that line the interior surface of blood vessels and lymphatic vessels. The endothelium forms an interface between circulating blood or lymph in the lumen and the rest of the ve ...
cells. It is the most common benign liver tumour, and is usually asymptomatic and diagnosed incidentally on
radiological imaging Medical imaging is the technique and process of imaging the interior of a body for clinical analysis and medical intervention, as well as visual representation of the function of some organs or tissues (physiology). Medical imaging seeks to rev ...
. Liver hemangiomas are thought to be congenital in origin.Baron R
'Liver: Masses Part I: detection and characterization'
. The Radiology Assistant 2006
Several subtypes exist, including the giant hepatic haemangioma, which can cause significant complications.


Diagnosis

Liver hemangiomas are typically
hyperechoic Echogenicity (misspelled sometimes as echogenecity) or echogeneity is the ability to bounce an echo, e.g. return the signal in ultrasound examinations. In other words, echogenicity is higher when the surface bouncing the sound echo reflects increa ...
on
ultrasound Ultrasound is sound waves with frequencies higher than the upper audible limit of human hearing. Ultrasound is not different from "normal" (audible) sound in its physical properties, except that humans cannot hear it. This limit varies ...
though may occasionally be
hypoechoic Echogenicity (misspelled sometimes as echogenecity) or echogeneity is the ability to bounce an echo, e.g. return the signal in ultrasound examinations. In other words, echogenicity is higher when the surface bouncing the sound echo reflects increa ...
; ultrasound is not diagnostic. Computed tomography (CT),Brodsky RI, Friedman AC, Maurer AH et-al. Hepatic cavernous hemangioma: diagnosis with 99mTc-labeled red cells and single-photon emission CT. ''AJR Am J Roentgenol''. 1987;148 (1): 125-9.
magnetic resonance imaging Magnetic resonance imaging (MRI) is a medical imaging technique used in radiology to form pictures of the anatomy and the physiological processes of the body. MRI scanners use strong magnetic fields, magnetic field gradients, and radio wave ...
(MRI)Vilanova JC, Barceló J, Smirniotopoulos JG et-al. Hemangioma from head to toe: MR imaging with pathologic correlation. ''Radiographics''. 24 (2): 367-85. or
single-photon emission computed tomography Single-photon emission computed tomography (SPECT, or less commonly, SPET) is a nuclear medicine tomographic imaging technique using gamma rays. It is very similar to conventional nuclear medicine planar imaging using a gamma camera (that is, ...
(SPECT) using autologous labelled Red Blood Cells (RBC) with Tc-99m is diagnostic. Biopsy is avoided due to the risk of haemorrhage. Hepatic hemangiomas can occur as part of a clinical syndrome, for example
Klippel–Trénaunay syndrome Klippel–Trénaunay syndrome, formerly Klippel–Trénaunay–Weber syndrome and sometimes angioosteohypertrophy syndrome and hemangiectatic hypertrophy, is a rare congenital medical condition in which blood vessels and/or lymph vessels fail t ...
, Osler–Weber–Rendu syndrome and
Von Hippel–Lindau syndrome The term ''von'' () is used in German language surnames either as a nobiliary particle indicating a noble patrilineality, or as a simple preposition used by commoners that means ''of'' or ''from''. Nobility directories like the ''Almanach de G ...
.


Types

* Typical hepatic hemangioma * Atypical hepatic hemangioma ** Giant hepatic hemangioma ** Flash filling hepatic hemangioma – can account for up to 16% of all hepatic hemangiomas ** Calcified hepatic hemangioma ** Hyalinized hepatic hemangioma ** Other unusual imaging patterns *** Hepatic hemangioma with capsular retraction *** Hepatic hemangioma with surrounding regional nodular hyperplasia *** Hepatic hemangioma with fatty infiltration *** Pedunculated hepatic hemangioma *** Cystic hepatic hemangioma – rare *** Fluid-fluid level containing hepatic hemangioma – rare


Giant hepatic hemangioma

This large, atypical hemangioma of the liver may present with abdominal pain or fullness due to hemorrhage,
thrombosis Thrombosis (from Ancient Greek "clotting") is the formation of a blood clot inside a blood vessel, obstructing the flow of blood through the circulatory system. When a blood vessel (a vein or an artery) is injured, the body uses platelets (th ...
or mass effect. It may also lead to left ventricular volume overload and
heart failure Heart failure (HF), also known as congestive heart failure (CHF), is a syndrome, a group of signs and symptoms caused by an impairment of the heart's blood pumping function. Symptoms typically include shortness of breath, excessive fatigue, ...
due to the increase in
cardiac output In cardiac physiology, cardiac output (CO), also known as heart output and often denoted by the symbols Q, \dot Q, or \dot Q_ , edited by Catherine E. Williamson, Phillip Bennett is the volumetric flow rate of the heart's pumping output: th ...
which it causes.Gardiner M, Eisen S, Murphy C. Training in paediatrics: the essential curriculum. Oxford University Press, Oxford 2009. Further complications are
Kasabach–Merritt syndrome Kasabach–Merritt syndrome, also known as hemangioma with thrombocytopenia, is a rare disease, usually of infants, in which a vascular tumor leads to decreased platelet counts and sometimes other bleeding problems, which can be life-threatenin ...
, a form of
consumptive coagulopathy Disseminated intravascular coagulation (DIC) is a condition in which blood clots form throughout the body, blocking small blood vessels. Symptoms may include chest pain, shortness of breath, leg pain, problems speaking, or problems moving parts ...
due to thrombocytopaenia, and rupture.


Imaging follow-up

A United States practice is to perform
liver ultrasound Abdominal ultrasonography (also called abdominal ultrasound imaging or abdominal sonography) is a form of medical ultrasonography (medical application of ultrasound technology) to visualise abdominal anatomical structures. It uses transmission ...
at 6 months and 12 months after the initial diagnosis, and if the size has not increased, further follow-up is not necessary. Particular situations that may indicate imaging are: * New onset
abdominal pain Abdominal pain, also known as a stomach ache, is a symptom associated with both non-serious and serious medical issues. Common causes of pain in the abdomen include gastroenteritis and irritable bowel syndrome. About 15% of people have a m ...
* Initiation of
estrogen therapy Hormone replacement therapy (HRT), also known as menopausal hormone therapy or postmenopausal hormone therapy, is a form of hormone therapy used to treat symptoms associated with female menopause. These symptoms can include hot flashes, vaginal ...
*
Pregnancy Pregnancy is the time during which one or more offspring develops ( gestates) inside a woman's uterus (womb). A multiple pregnancy involves more than one offspring, such as with twins. Pregnancy usually occurs by sexual intercourse, but ...
* Hemangiomas larger than 10 cm, where it can be appropriate to perform an ultrasound follow-up annually.


See also

* Hemangioma * Liver tumour


References


External links

{{Vascular tumors Benign neoplasms Hepatology