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What
is Hepatic (Liver) Cavernous Hemangioma?
Hepatic or
liver hemangioma or cavernous hemangioma is probably
the most common misnomer in medical literature. The
correct terminology should be hepatic venous
malformations. These benign vascular lesions can
change in size slightly and also in color due to
cycles of clotting within the lesion. There may be a
single or multiple hemangioma lesions (venous
malformations) in the liver.
These lesions are actually simple venous
malformations and very common in the general
population. When they are small, they are completely
harmless and do not require any extensive testing or
treatment. Although it is commonly stated that
biopsy of these lesions may be dangerous because of
the potential for significant bleeding, which is
probably overstated, but the potential risk of
bleeding exists similar to any other liver or liver
lesion biopsy procedure.
What
is the ideal diagnostic test for liver hemangioma?
Hepatic
hemangiomas can be easily recognized by an
experienced radiologist on ultrasonography, CT, MRI
or nuclear medicine scan. Since ultrasonography (US)
and CT are the most practical tests, they should be
utilized initially; MRI and nuclear scan should be
used if there are any remaining questions. In
general, contrast-enhanced CT is quite satisfactory
to make accurate diagnosis in the majority of
patients.
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These
two ultrasound (US) images from the same
patient (2nd image obtained 2 months
after the first image) show a typical
liver hemangioma (venous malformation)
in the right lobe of the liver, which
changes in size and ultrasound color (echogenicity) on the follow-up
scan.
Post-contrast
MR imaging of the liver demonstrating nodular
peripheral enhancement of the right hepatic
lobe lesion. First image demonstrates
completely hypointense rounded lesion, which
shows peripheral enhancement in the subsequent
phases. This enhancement pattern is typical
for liver venous malformations
("cavernous hemangiomas").
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First
image is a gray-scale US image showing a
relatively small rounded bright lesion with
distal shadowing. This is a typical
sonographic finding. 2nd image is a coronal T2
weighted MR image demonstrating a slightly
larger rounded bright lesion. Liver venous
malformations ("hemangiomas")
demonstrate bright signal on T2 MRI
images. |
Do
hepatic venous malformations (hemangioma or
cavernous hemangioma) need to be treated?
When
the patient is asymptomatic, there is no need for
treatment regardless of its size. However, potential
risks such as bleeding exist particularly in liver
hemangiomas that are large and located near the
capsule or the capsule of the liver is involved. In
these cases, excessive physical activities or
potential trauma sources should be avoided.
There are some reports describing the
transcatheter embolization procedure for liver
hemangiomas, but it is not advisable similar to
other venous malformations. Although it has not been
tested, percutaneous sclerotherapy
may be a great treatment alternative to surgical
excision if treatment is needed.
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