Hepatic hemangioendothelioma: Prenatal sonographic findings and evolution of the lesion

Abstract

We describe a case of hepatic hemangioendothelioma that was first suspected based on prenatal sonographic findings at 19 weeks' menstrual age. At 16 weeks, the patient presented with a markedly elevated maternal serum α‐fetoprotein level. Serial sonographic examinations revealed that the fetus had cardiomegaly, hepatomegaly with a hepatic mass and dilated intrahepatic vessels, a single umbilical artery, and a placental chorioangioma. Arteriovenous shunting within the hepatic mass was seen using color Doppler and pulsed Doppler sonography. An enlarged artery arising from the abdominal aorta supplying the mass was demonstrated. Postnatal physical examination and radiologic studies supported the diagnosis of hepatic hemangioendothelioma. The evolution in the sonographic appearance of this hepatic lesion in utero over a 17‐week period is described. © 2000 John Wiley & Sons, Inc. J Clin Ultrasound 28:258–263, 2000.

Hepatic haemangioma—prenatal imaging findings, complications and perinatal outcome in a case series

“…In his review article concerning foetal and neonatal hepatic tumours, Isaacs [3] reported that 33 of the 117 hemangiomas encountered were prenatally diagnosed, including 26 focal tumours, but detailed references are not available. We have included the 19 reported cases that appeared to be fully documented in Table 3 [12][13][14][15][16][17][18][19][20][21][22]. Most, as found in our series, were detected during the third trimester of pregnancy, but Figs.…”

“…Dilatation of hepatic veins can be secondary either to high output flow from the tumour or to cardiac failure (all three veins dilated). Only one report described large hepatic veins associated with a solitary haemangioma and cardiac failure, and postnatal outcome after birth was not addressed in this [16].…”

“…As described on postnatal exams, the US aspect suggestive of HH was that of a focal or multifocal hepatic mass with multiple internal vessels associated with a large hepatic artery and/or enlargement of one or more hepatic veins. On MRI we expected the tumours to be hyperintense compared to liver on T2-W sequences and hypointense on T1-W sequences [12][13][14][15][16][17][18][19][20][21][22].…”

“…Specific perinatal management may be required when foetuses present complications. There have been very few reports about foetal HH and no series has been large enough to evaluate prognostic factors and management [12][13][14][15][16][17][18][19][20][21][22].…”

Congenital hemangiomas and infantile hemangioma: missing links

“…23,24 In two instances, the neonate died of complications of the tumor. 25,26 There are also examples of antenatal diagnosis of single and multiple intrahepatic hemangiomas, [27][28][29] and two case reports of prenatal treatment of the fetus, via the mother, either with corticosteroid 30,31 or interferon. 32 But not all congenital hemangiomas shrink in the first year-some do not regress at all.…”