Propranolol as first‐line treatment for life‐threatening diffuse infantile hepatic hemangioma: A case report

Varrasso, Giulia; Schiavetti, Amalia; Lanciotti, Silvia; Sapio, Maria Del; Ferrara, Eva; Grazia, Alessandra De; Clerico, A.

doi:10.1002/hep.29028

Cited by 21 publications

(13 citation statements)

References 5 publications

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“…Randomised clinical trials have confirmed that the efficacy and safety of propranolol are better than that of corticosteroids in the treatment of cutaneous IHs . Recently, several case report studies have also shown the efficacy of propranolol in the treatment of IHH …”

Section: Discussionmentioning

confidence: 98%

Efficacy of propranolol treatment in infantile hepatic haemangioma

Yang

Peng

Chen

et al. 2019

J Paediatrics Child Health

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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.

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Section: Discussionmentioning

confidence: 98%

Efficacy of propranolol treatment in infantile hepatic haemangioma

Yang

Peng

Chen

et al. 2019

J Paediatrics Child Health

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“…While propranolol’s mechanism of action is partially unknown, its benefits can include vasoconstriction, apoptosis of the capillary endothelial cells and decreased expression of the vascular endothelial growth factor and fibroblast growth factor [9, 12]. Since treatment with steroids can increase the activity of propranolol, some authors have also suggested an association between propranolol and prednisone during therapy for diffuse IHH [13, 14]. …”

Section: Discussionmentioning

confidence: 99%

Diffuse infantile hepatic haemangioma—how to manage an incidental but potentially lethal finding

Rodrigues

Forno

Costa

et al. 2018

Oxford Medical Case Reports

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Infantile hepatic haemangioma (IHH) is a rare vascular tumour that is potentially lethal due to its associated complications, including heart failure, hepatic failure, hypothyroidism and abdominal compartment syndrome. The authors report a case of an asymptomatic diffuse IHH in a newborn male, which was presented as an incidental finding at the time that the patient was diagnosed with pyloric stenosis. The patient was treated with increasing doses of propranolol that were well tolerated. With the regression of the IHH by the time that the patient reached one year of age, there was a significant imagiologic improvement. Because there is no consensus on the optimal approach for the treatment of liver tumours in newborns, it is important to adopt a systematic approach. After the diagnosis of diffuse IHH has been established, the decision to initiate treatment and the therapeutic of choice is often controversial. Regular follow-up is recommended to monitor possible complications.

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“…Los mecanismos de acción incluirían vasoconstricción por inhibición de la liberación de óxido nítrico, bloqueo de señales proangiogénicas e inducción de apoptosis en las células endoteliales. 2,3,6,7,9 En cuanto a la indicación de tratamiento, el uso de propranolol está limitado a las lesiones sintomáticas con insuficiencia cardíaca congestiva, síndrome de Kasabach-Merritt o compartimental. La dosis recomendada es de 1-3 mg/kg/día cada 6-8 horas por vía oral con la evaluación cardiológica previa que descarte contraindicaciones, como bloqueos cardíacos.…”

Section: Figura 3 Ecografía Abdominal Dopplerunclassified

“…En el caso de los hemangiomas hepáticos difusos, el tratamiento estaría justificado, aun en pacientes asintomáticos, por el alto riesgo de progresión clínica 1,6. En nuestro paciente en particular, se indicó tratamiento inicial con esteroides sin respuesta a este, por lo que se inició propranolol al tercer día de vida, con muy buena respuesta clínica.…”

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Tratamiento con propranolol en el síndrome de Kasabach-Merritt secundario a hemangioma hepático congénito. Caso clínico

Soria

Malla

2021

Arch Argent Pediat

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Propranolol as first‐line treatment for life‐threatening diffuse infantile hepatic hemangioma: A case report

Cited by 21 publications

References 5 publications

Efficacy of propranolol treatment in infantile hepatic haemangioma

Efficacy of propranolol treatment in infantile hepatic haemangioma

Diffuse infantile hepatic haemangioma—how to manage an incidental but potentially lethal finding

Tratamiento con propranolol en el síndrome de Kasabach-Merritt secundario a hemangioma hepático congénito. Caso clínico

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