From the Guidelines
The typical management approach for a hemangioma in the left hepatic lobe of the liver is observation with regular monitoring, as most hepatic hemangiomas are asymptomatic and benign. These lesions generally do not require treatment unless they cause symptoms or meet specific criteria for intervention. According to the most recent guidelines, haemangiomas can usually be managed conservatively 1. For asymptomatic hemangiomas, periodic imaging surveillance with ultrasound or MRI every 6-12 months is usually sufficient to ensure stability.
Key Considerations
- Intervention is typically considered only when hemangiomas are symptomatic (causing pain, early satiety, or nausea), rapidly growing, very large (>5-10 cm), causing compression of adjacent structures, or if there is uncertainty about the diagnosis.
- The risk of hepatic rupture in a giant (>4 cm) liver haemangioma was found to be 3.2%, with increased risk in peripherally located and exophytic lesions 1.
- When treatment is necessary, surgical resection is the definitive approach, with left hepatic lobectomy or segmentectomy being appropriate for left lobe lesions.
- Less invasive alternatives include arterial embolization to reduce blood flow to the hemangioma, radiofrequency ablation for smaller lesions, or radiation therapy in select cases.
Diagnostic Approach
- Contrast-enhanced ultrasound (CEUS) is very useful in the diagnosis of hepatic hemangioma, with typical findings including peripheral nodular enhancement in the arterial phase and complete or incomplete centripetal filling in the portal venous and late phases 1.
- MRI can be complementary to CEUS in uncertain cases, especially in patients with suspected metastatic disease.
- Biopsy and histological examinations are still mandatory for determining the appropriate therapy in these patients.
Outcome
The conservative approach is justified because hepatic hemangiomas are composed of blood-filled vascular channels that rarely undergo malignant transformation, and most remain stable or may even regress over time 1. Complications such as spontaneous rupture or hemorrhage are extremely rare, occurring in less than 1% of cases.
From the Research
Typical Management Approach for Hemangioma in the Left Hepatic Lobe
The management of a hemangioma in the left hepatic lobe of the liver depends on various factors, including the size of the tumor and the presence of symptoms.
- Small- to medium-sized hemangiomas (less than 4 cm) are typically asymptomatic and do not require active treatment, with regular follow-ups being sufficient 2, 3.
- Giant hemangiomas (larger than 5 cm) have a higher risk of complications and may require intervention, such as surgical resection or transarterial embolization 4, 5, 6.
- The presence of symptoms, such as abdominal pain, mass, distention, early satiety, and weight loss, may also necessitate treatment 3, 4.
Treatment Options
Treatment options for hemangiomas in the left hepatic lobe include:
- Conservative management for asymptomatic, small- to medium-sized hemangiomas 2, 5.
- Surgical resection, including enucleation, for symptomatic or complicated hemangiomas 3, 4, 6.
- Transarterial embolization as a minimally invasive alternative to surgery 3, 5.
- Other therapies, such as radiofrequency ablation, radiotherapy, and liver transplantation, may also be considered in certain cases 4.
Diagnosis and Imaging
Diagnosis of hemangiomas in the left hepatic lobe is typically made using imaging modalities, such as: