Efficacy of propranolol treatment in infantile hepatic haemangioma

Abstract

Aim: The aim of this study was to assess the efficacy of propranolol treatment in multifocal and diffuse infantile hepatic haemangioma (IHH). Methods: A retrospective study of symptomatic or potentially symptomatic IHH was performed in our hospital between 2011 and 2016. Results: Thirteen patients were identified: 2 patients had diffuse lesions, and 11 patients had multifocal lesions, including 2 patients who had combined lesions that shared features of both multifocal and diffuse lesion patterns. Eleven (84.6%) patients had cutaneous infantile haemangioma. Hepatomegaly was the predominant clinical presentation. Hypothyroidism was identified in three patients, including one patient who had documented congestive heart failure (CHF). The median age at diagnosis and the median duration of treatment were 2.0 months (range 1.2-26.0) and 24.0 months (range 4.0-30.0). The median duration of follow-up was 30.0 months (range 3.0-48.0). For patients with hypothyroidism, the thyroid hormone level was normal after 4 weeks of propranolol and levothyroxine treatment. All but one patient responded well to propranolol treatment. The patient who failed to respond to treatment died of CHF and abdominal compartment syndrome induced by hepatomegaly. No significant side effects of propranolol were observed during follow-up. Conclusions: Most multifocal and diffuse IHH respond well to propranolol. However, progressive cases may be fatal despite aggressive treatments. Our data suggest that propranolol may be considered the first-line treatment for multifocal and diffuse IHH due to its efficacy.

Successful Medical Management of Life-threatening Hepatic Hemangioma in Neonates

“…6 Most multifocal and diffuse HHs, like infantile HHs elsewhere in the body, respond well to propranolol; therefore, it is considered as a firstline therapy. 7 CHHs are typically focal lesions that have the characteristic peripheral enhancement and often reveal high flow. This is associated with the risk of CHF and, rarely, life-threatening hemorrhage.…”

Multifocal cutaneous infantile haemangiomata: A multisystem disorder with persistent hypopituitarism

“…Amongst patients with consumptive hypothyroidism, thyroid hormone levels have been noted to normalise in 4 weeks following treatment. 14 Our unique case highlights the potential for persistent hypopituitarism as a consequence of IH. This may have resulted from venous shunting and congestion of the hypophyseal portal system resulting in permanent anterior pituitary dysfunction.…”

“…Duration of therapy is dependent upon the rate of regression of the lesions but can range from 2 to 6 months. Amongst patients with consumptive hypothyroidism, thyroid hormone levels have been noted to normalise in 4 weeks following treatment 14 …”

Case reports of large and symptomatic abdominal tumors in newborns: Pitfalls, difficulties in management, and surgical decision making

“…In our study, among the five newborns who underwent surgery, increasing need for ventilatory support was the primary indication for surgery in four newborns. Even though one of the masses (hepatic hemangioma in case three) could have been treated with systemic corticosteroids or propranolol, 10 the newborn's rapidly worsening clinical condition meant that abdominal decompression was necessary.…”