Giant Fetal Hepatic Hemangioma

Abstract

The purpose of this case report is to demonstrate the importance of prenatal imaging for treatment management of fetal giant hepatic hemangiomas. Prenatal ultrasound revealed an abdominal mass with several cystic areas and punctate calcifications in a fetus at 29 weeks’ gestation. Doppler scans confirmed the highly vascular nature of the mass. In this case, ultrasound diagnosed the mass was of hepatic origin, while magnetic resonance imaging at 32 weeks’ gestation was more equivocal with respect to the anatomy source of the lesion. Imminent hydrops caused by a rapidly enlarged liver tumor was sonographically demonstrated at 34 weeks’ gestation. An elective C-section and immediate tumor resection was performed. At the age of 20 months the infant is thriving. This case supports the notion that the survival rates for giant hepatic hemangiomas improve when fetal hydrops is averted and specific pre- and postnatal treatment is applied based on correct prenatal imaging diagnostics.

Rapidly involuting congenital haemangioma of the liver

“…This consumptive coagulopathy is distinct from the Kasabach-Merritt syndrome, which is associated with profound thrombocytopaenia,19 fibrinogen consumption and secondary formation of D-dimer 20. Disseminated intravascular coagulation21 and hepatic failure have been reported as rare complications of RICH 16. However, most of the time coagulation profile corrects with involution of the lesion.…”

Huge fetal hepatic Hemangioma: prenatal diagnosis on ultrasound and prognosis

“…Small hepatic hemangiomas are often asymptomatic and seldom require treatment. In contrast, huge hepatic hemangiomas (mean diameter > 4 cm) are less frequently reported than small hepatic hemangiomas [ 7 ] and can cause serious complications [ 8 , 9 ]. Without prompt intervention, neonatal mortality rates reach 30–100% [ 10 – 12 ].…”

Successful Use of Propranolol in a Symptomatic Giant Congenital Hepatic Hemangioma

“…4 Focal hepatic hemangiomas are well-defined solitary and spherical lesions, which, when larger than 4.0 cm, are classified as giants and represent higher mortality. 4, 13, 14 These lesions do not stain positive to the GLUT–1 marker, so they are considered CHH. 15…”

“…In refractory, severe, or noninvoluting cases, invasive procedures such as lobectomies, tumor resection, embolization, and even transplantation occur. 13, 15, 25, 29-32 Propranolol is the therapy of choice for infantile hemangiomas, 10-12 and these findings have been extrapolated for hepatic or visceral hemangiomas. In CHH, its use has had mixed results with partial, complete, or no improvement; 16, 30, 33-35 however, because most CHH involute, the effect may not be entirely attributed to the medication.…”