Hemangioma is a benign tumor which consists of great number of irregular, entangled blood vessels filled with blood. It can develop at any age and affect any organ. Hepatic hemangioma affects liver, and it is by far most frequent benign liver tumor. The cause of this tumor is unknown, but it is suggested that interaction between genetic and environmental factors plays an important role.
Liver hemangioma affects about 2% of population, and is the most common in persons aged between 30 and 50. The disease is predominantly found in women (F : M = 5 : 1), which suggests the role of female sex hormones in the development of the tumor. It has been found that pregnancy, estrogen therapy, and steroids can contribute to faster progression of the tumor.
The diagnosis of liver hemangioma is not easy. They are usually asymptomatic and are noticed by accident during liver or abdomen imaging techniques performed for other reasons. If the hemangioma grows larger than 4 cm, it causes symptoms in 40% of patients, while symptoms are present in 90% of patients with hemangiomas larger than 10 cm. The most common symptoms include the feeling of fullness and discomfort in right upper quadrant of abdomen. Enlarged liver could be found in those patients, although it is not an obligate finding. Very rare presentations include heart failure because of massive blood redistribution to hemangioma blood vessels and fever. Sharp periodic pain can be experienced by patients with big hemangiomas that compress gallbladder. Spontaneous rupture of these hemangiomas is very rare, but the rupture can be caused by physical trauma.
The diagnosis is established using imaging procedures such as ultrasound, CT and MRI. All the standard laboratory tests are often normal. Ultrasound is usually the first method to be used, and it has good success, especially if used with color Doppler. MRI is more expensive, but it is proven to be the most accurate imaging technique for diagnosing liver hemangioma with the sensitivity of 96%.
When the diagnosis of liver hemangioma is established, a periodic follow-up of tumor development is required. Ultrasonography is usually used for that purpose. If the tumor size remains unchanged for 12 months after diagnosis, the follow-up is no longer needed. Of course, that is not the rule for hemangiomas larger than 10 cm and in patients with substantial symptoms.
Surgical removal of liver hemangioma is recommended for large tumors that cause significant symptoms. There are also newer techniques that are less invasive such as embolization, radio-wave therapy, and radiation therapy. However, recommendations for patients with liver hemangioma differ and the right decision has to be made for each patient individually, according to clinical presentation.
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