Liver (hepatic) Cavernous Hemangioma

 

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.

 

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"). 

 

   

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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