Liver hemangiomaD18.03

Most frequent benign liver tumor, which is usually discovered by chance during a routine sonographic examination. 80% of liver hemangiomas have a diameter < 3cm. During pregnancy and when taking preparations containing estrogen and progesterone they may show tendencies to grow (this also applies to capillary angiomas of the skin ).

Detectable in 10% of autopsies. w:m=3:1

Average age at detection 50 years (Taseva A et al. 2013)

In the vast majority of cases, patients are completely free of complaints. In rare cases hemangiomas of the liver become clinically conspicuous. In addition to unspecific chronic complaints, thrombosis or bleeding of hemangiomas can also cause severe acute abdominal pain. Fever and abnormal liver values may also occur

Mostly accidental findings during a sonographic examination of the abdominal cavity. Sonographically there is an echogenic (white) roundish-oval or structured, smooth-edged area. Iris diaphragm phenomenon in contrast medium sonography (CEUS). Colour duplex: several vessels at the edges.

The angiomas of the adult liver are pathogenetically and clinically distinct from the eruptive liver hemangiomas of infants, which can occur together with hemangiomas of the skin (Canty KM et al. 2014). S.u. hemangiomatosis of the infant. In type II of neonatal hemangiomatosis, the so-called diffuse neonatal hemangiomatosis, there is multiple skin and system involvement (skin: 100%, liver: 64%, brain: 52%, gastrointestinal tract: 52%, oral: 44%, eyes: 32%). A 43% liver involvement is to be expected in the segmental infant hemangioma (Metry DW et al. 2004).

In large hemangiomas very rarely spontaneous rupture or rupture after blunt abdominal trauma. Possible bleeding into the abdominal cavity.

As a rule, treatment is not necessary. Asymptomatic patients with hemangiomas with a diameter < 1.5 cm can be observed at larger intervals (initially annually, then extending the intervals to 3 years). Large hemangiomas should be monitored at closer intervals, especially if they are directly under the liver capsule.

In the case of larger hemangiomas, sports with the risk of blunt abdominal trauma should be avoided due to the risk of rupture. Patients with severe pain symptoms due to compression of other organ structures should be operated on.

1. Canty KM et al (2014) Multiple cutaneous and hepatic hemangiomas in infants. South Med J 107:159-164.
2. Metry DW et al (2004) Association of solitary, segmental hemangiomas of the skin with visceral hemangiomatosis. Arch Dermatol 140:591-596.
3. Taseva A et al (2013) Diagnosis of liver hemangioma. Khirurgiia 3:8-13.