Imaging Pearls ❯ Liver ❯ Hemangioma
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- “The most common hepatic tumor is the hepatic hemangioma, which has a frequency of 0.4–20%. These benign neoplasms can be diagnosed at any age, but are more common among female patients than male patients (ratio, 3:1) [28–33]. Hem- angiomas can vary in size; those larger than 5 cm are categorized as giant hemangiomas The cause is poorly understood, but they are considered vascular malformations. Their size can be affected by hormones (estrogen and progesterone) .”
Liver Calcifications and Calcified Liver Masses: Pattern Recognition Approach on CT Madhavi Patnana et al AJR 2018; 211:76–86 - “Larger hemangiomas can have complications resulting in abdominal pain, fullness, thrombosis, and brosis or have focal stromal calcifications, which are frequently coarse and large. Calci cations are vi- sualized in 10–20% of hemangiomas and typically located in areas of central fibrosis. A much less common appearance includes the presence of phleboliths .”
Liver Calcifications and Calcified Liver Masses: Pattern Recognition Approach on CT Madhavi Patnana et al AJR 2018; 211:76–86
- “In our series, suggestive features of sclerosed hemangiomas include geo- graphic outline, capsular retraction, decrease in size over time, and loss of previously seen regions of enhancement. Additional features include presence of transient hepatic attenuation difference (THAD), rim enhancement, and nodular regions of intense enhancement as seen in typical hemangiomas. Although not pathognomonic, some features of sclerosed hemangioma can suggest it as a diagnostic possibility and lead to biopsy rather than more extensive intervention.”
Imaging Features of Sclerosed Hemangioma Deirdre J et al. AJR 2007; 189:67–72 - “Hemangiomas that undergo degeneration and fibrous replacement are called sclerosed, thrombosed, or hyalinized hemangiomas.”
Imaging Features of Sclerosed Hemangioma Deirdre J et al. AJR 2007; 189:67–72 - “The process of sclerosis generally begins in the center of a hepatic hemangioma and can extend to involve the entire lesion. The term “sclerosed” is reserved for hemangiomas that are predominantly fibrosed with near complete obliteration of the vascular spaces.”
Imaging Features of Sclerosed Hemangioma Deirdre J et al. AJR 2007; 189:67–72 - “In our series, features suggestive of sclerosed hemangiomas included geographic pattern, capsular retraction, decrease in size over time, and loss of previously seen regions of enhancement. Additional features included the presence of transient hepatic attenuation difference, rim enhancement, and nodular regions of intense enhancement as seen in typical hemangioma.”
Imaging Features of Sclerosed Hemangioma Deirdre J et al. AJR 2007; 189:67–72
- “The cavernous haemangioma is the most common histological sub-type and corresponds to the classic semiological description of the haemangioma in imaging.This is a lesion consisting of large vascular spaces with a central cavernous zone, all the larger with a voluminous haemangioma, and not very extensive connective tissue.In general, this typical appearance is observed in lesions less than 3 cm in diameter. The outlines are sharp, well defined.”
Hepatic haemangioma: Common and uncommon imaging features T. Klotz et al. Diagnostic and Interventional Imaging Volume 94, Issue 9, September 2013, Pages 849–859 - “Certain haemangioma may degenerate with an extensive fibrosis beginning at the centre of the lesion at the origin of the obliteration of the vascular spaces. This is also called a thrombosed or hyalinised haemangioma.The criteria indicating the diagnosis of sclerosed haemangioma are the geography map appearance associated with a reduction in the volume of the hepatic parenchyma with capsular retraction. Lesional heterogeneity may also exist with the presence of cystic, haemorrhagic or fibrous patches.”
Hepatic haemangioma: Common and uncommon imaging features T. Klotz et al. Diagnostic and Interventional Imaging Volume 94, Issue 9, September 2013, Pages 849–859 - “Haemangiomatosis is rare and asymptomatic in the adult. It is more often found in the child where it may be associated with congestive heart failure. The lesions are large, poorly defined, confluent, replacing almost all of the hepatic parenchyma.” Hepatic haemangioma: Common and uncommon imaging features T. Klotz et al. Diagnostic and Interventional Imaging Volume 94, Issue 9, September 2013, Pages 849–859
- “This consists of a relatively common association involving about 20% of all patients with focal nodular hyperplasia. This association is also more often noted in cases of multiple focal nodular hyperplasia and in case of treatment with oral contraceptives. In fact, nodular and focal hyperplasia is a hyperplastic response to the focal increase in the arterial flow potentially generated by a haemangioma. When these lesions maintain a typical appearance in imaging, the diagnosis does not require histological proof.”
Hepatic haemangioma: Common and uncommon imaging features T. Klotz et al. Diagnostic and Interventional Imaging Volume 94, Issue 9, September 2013, Pages 849–859 - “Comprising almost 90% of the hepatic vascular anomalies in the child , infantile hepatic haemangiomas may present themselves in the form of an asymptomatic abdominal mass or induce serious, possibly life-threatening, complications (congestive heart failure due to the association with large arterioportal shunts; Kasabach-Merrit syndrome: coagulopathy due to the intra-lesional platelet sequestration; severe hypothyroidism; anaemia and haemoperitonitis on spontaneous rupture).”
Hepatic haemangioma: Common and uncommon imaging features T. Klotz et al. Diagnostic and Interventional Imaging Volume 94, Issue 9, September 2013, Pages 849–859 - “Although, in the vast majority of cases, the radiological diagnosis of hepatic haemangioma is clearly established, certain semiological atypies may make the diagnosis difficult. The presence of a lesional continuum between the capillary, cavernous and sclerosed haemangiomas may account for the radiological variants. The haemangioma appears as an active vascular lesion in interaction with its immediate environment that may be at the origin of arterioportal shunts, perilesional zones free of steatosic infiltration, focal nodular hyperplasias, compressions on the bile ducts and hepatic capsular retraction.”
Hepatic haemangioma: Common and uncommon imaging features T. Klotz et al. Diagnostic and Interventional Imaging Volume 94, Issue 9, September 2013, Pages 849–859
- “The right indications for surgery remain rupture, intratumoral bleeding, Kasabach-Merritt syndrome and organ or vessels compression (gastric outlet obstruction, Budd-Chiari syndrome, etc.) represents the valid indication for surgery and at the same time they are all complications of the tumor itself. The size of the tumor do not represent a valid indication for treatment.”
What is changing in indications and treatment of hepatic hemangiomas. A review.
Toro A et al.
Ann Hepatol. 2014 Jul-Aug;13(4):327-39. - “ Liver hemangiomas, when indication exist, have to be treated firstly by surgery (hepatic resection or enucleation, open, laproscopic or robotic), but in the recent years other therapies like liver transplantation, radiofrequency ablation, radiotherapy, trans-arterial embolization, and chemotherapy have been applied.”
What is changing in indications and treatment of hepatic hemangiomas. A review.
Toro A et al.
Ann Hepatol. 2014 Jul-Aug;13(4):327-39. - “ In conclusion, at two-phase spiral CT, the most common contrast-enhancement patterns of hemangioma are peripherally nodular high and/or uniform high during the arterial and portal venous phases. However, hemangiomas smaller than 2 cm may have atypical enhancing patterns including low and iso-attenuation.”
Hepatic hemangioma: contrast-enhancement pattern during the arterial and portal venous phases of spiral CT.
Yun EJ et al.
Abdom Imaging. 1999 May-Jun;24(3):262-6. - “The incidence of hemangiomas is 2–7% in the general population. Hemangiomas are the most frequent benign hepatic tumors and are usually found in patients aged between 40 and 60 years, more frequently in women. In 30–35% of patients the lesions are multiple. If larger than 4–10 cm, they are termed ‘giant’ hemangiomas.”
Giant hemangiomas of the liver: surgical strategies and technical aspects
Berloco P et al.
HPB (Oxford). 2006; 8(3): 200–201.
- Hemangioma
- Female predominance
- Hepatic artery vascular supply
- Peripheral, nodular enhancement with progressive fill-in
- Large lesions can demonstrate a central scar or calcification
- Unencapsulated
- Hemangioma
- Female predominance
- Hepatic artery vascular supply
- Peripheral, nodular enhancement with progressive fill-in
- Large lesions can demonstrate a central scar or calcification
- Unencapsulated
- Hepatic Hemangiomas: Clinical Syndromes
- Klippel-Trenaunay-Weber syndrome
- Osler-Rendu-Weber disease
- Von Hippel-Lindau disease