From the Guidelines
Hepatic hemangiomas are usually managed conservatively, with intervention limited to large lesions complicated by abdominal pain, bleeding, or rupture.
Management Approach
- The majority of hepatic hemangiomas do not require treatment and can be managed with close monitoring 1.
- Resection is rarely required, but can be performed during pregnancy in case of rapidly enlarging cases or in those complicated by rupture 1.
- Imaging with ultrasound is recommended to monitor haemangioma size in those at higher risk of rupture (large or exophytic) 1.
Risk Assessment
- The risk of hepatic rupture in a giant (>4 cm) liver haemangioma is approximately 3.2%, with increased risk in peripherally located and exophytic lesions 1.
- Lesions >10 cm have a higher risk of rupture, approximately 5%, and discussion of treatment prior to conception should be considered 1.
Pregnancy Considerations
- Hepatic hemangiomas do not preclude pregnancy, but close monitoring is recommended 1.
- Imaging is recommended during each trimester of pregnancy to monitor haemangioma size in those at higher risk of rupture 1.
From the Research
Management of Hepatic Hemangioma
The management of hepatic hemangioma can be divided into several approaches, including:
- Conservative management: Most hepatic hemangiomas are asymptomatic and can be managed conservatively, with no need for surgical intervention 2.
- Surgical management: Surgical resection or enucleation may be considered for symptomatic patients, especially those with large tumors (>4 cm) or those who experience incapacitating pain, diagnostic doubt, or compression of adjacent organs 2, 3.
- Interventional management: Interventional radiology techniques, such as transarterial embolization, ablation, percutaneous sclerotherapy, and percutaneous argon-helium cryotherapy, may be used to manage symptomatic hepatic hemangiomas 4, 5.
Indications for Treatment
Treatment is usually reserved for symptomatic patients, and the optimal management approach depends on multiple factors, including:
- Tumor size: Large tumors (>4 cm) are more likely to be symptomatic and may require surgical or interventional management 2, 3.
- Symptoms: Patients with incapacitating pain, diagnostic doubt, or compression of adjacent organs may require surgical or interventional management 2, 3.
- Location: Tumors located in the left hepatic lobe may be more challenging to manage due to their proximity to vital structures 6.
Complications and Risks
Surgical and interventional management of hepatic hemangiomas can be associated with complications, including:
- Postoperative complications: Such as bleeding, infection, and liver dysfunction 3.
- Recurrence: Multiple and/or giant hemangiomas may have a higher recurrence rate after treatment 5.
- Symptom relief: Treatment may not always achieve complete symptom relief, especially in patients with multiple and/or giant hemangiomas 5.