Hepatic Hemangioma

Hemangiomas are benign (not cancer) growths of extra blood vessels. Similar to hemangiomas on the skin, children may develop hemangiomas in the liver.

Symptoms/History

They may start growing in-utero and be completely mature at birth (congenital hemangioma) or initiate to proliferate in the first few weeks of life (infantile hemangioma). Later, generally around 6 to 18 months of age, they begin to slowly improve, a process called involution. Most hemangiomas have started to involute significantly between 1 and 3 years of age, and have mostly disappeared by the time a child starts kindergarten.

Liver hemangiomas are rarely symptomatic. The large majority are found incidentally and mostly never affect the liver function. At the extreme of the spectrum, the very large ones may cause heart failure, hypothyroidism or require liver transplant.

Diagnosis

Clinical exam. Sometimes a physician may feel an enlarged liver during a normal evaluation. Usually the small liver hemangiomas are not detected by normal physical examination.

Imaging. Imaging is important for liver hemangiomas (ultrasound of the liver), both at diagnosis and as monitoring. It monitors the size and blood flow in the hemangioma. Does not use radiation and does not require sedation of the baby.

Pathology. Hemangiomas are most often diagnosed by physical examination and so rarely require a biopsy (when a small piece of the liver is taken for examination under the microscope).

Genetics (if applicable) There is no known gene that causes hemangiomas and thus genetic testing is unnecessary.

Treatment

Since all hemangiomas involute, not every child needs treatment. The most common reasons for treatment include concerns regarding pressure on the surrounding organs in the abdomen, hypothyroidism and cardiac failure (when the hemangioma is shifting too much blood out the normal blood vessels and into the liver).

A number of treatment options may be offered. These include:

• oral (by mouth) medications (usually propranolol)
• endovascular therapy (embolization) and
• surgery.

In general, medical and endovascular therapy are used during infancy to control hemangioma growth or for complications management. Surgical options are generally considered later, following some or complete involution if needed.

The choice of which treatment is best is individual and depends on:

• your child’s age
• hemangioma characteristics (how big, how many hemangiomas, how much blood flow)
• how quickly the hemangioma is growing or involuting, and
• the type and severity of any associated complications. 

It is very important for your child to be monitored by the medical team until the hemangiomas have disappeared completely and not to stop the follow-up process at the beginning of involution period.