Hepatic haemangioma: a critical review of diagnosis and management

Twenty-four adults (10 male; age 27-65 years, median 43.5) with hepatic haemangioma are reviewed. Fifteen had right hypochondrial pain (lesions 8 cm or more in diameter in nine). Six lesions were found incidentally, at ultrasound examination or elective cholecystectomy. Diagnosis, from ultrasonic and angiographic appearances, was confirmed in 12 by percutaneous biopsy without complication. Eleven patients were followed untreated for up to 60 months (median 24 months): lesion size (median 2.5 cm) did not change and all remained well. Surgical resection succeeded in two of three patients; the third and eight other patients (seven with symptoms) with lesions 3 to 30 cm in diameter were selected for Gelfoam embolization. Transient minor side effects preceded improvement in most, but two patients (with lesions of 20 cm or greater in diameter) developed multiple liver abscesses: recovery was protracted. Embolization failed in three; two remain well, untreated, to 24 and 51 months. Two patients had hepatic artery ligation, one with radiotherapy. Further imaging at from eight to 60 months (median 24) showed little change in lesion size or vascularity with any non-resectional technique. Expectant management of small asymptomatic haemangiomas appears appropriate. Embolization may reduce pain but the risk of abscess formation is high for large tumours, and reduction in size or vascularity of lesions is unlikely whatever their initial diameter.