What are Hepatic Hemangiomas?
Hepatic Hemangiomas (HH) are benign, vascular tumors in the liver. There are two subtypes: Infantile hepatic hemangiomas (IHH), which develop rapidly after birth and decrease in size over time, and congenital hemangiomas (CH), which are fully developed at birth.
IHH affects approximately 4-5% of term infants, predominantly females and Caucasians. CH is rare, affecting about 1 in 200,000 children.
What causes Hepatic Hemangiomas?
IHH and CH may be caused by vascular malformations or genetic mutations, though the exact causes remain unclear. While the exact cause of HH is unknown, there are several risk factors associated with IHH, including female gender, Caucasian ethnicity, low birth weight, prematurity and prenatal hypoxia. For CH, genetic mutations may play a role, but no specific risk factors have been identified. There is a familial tendency for some cases, indicating possible hereditary factors.
What are the symptoms of Hepatic Hemangiomas?
- Pain in the upper right abdomen
- Feeling full after eating a small amount of food
- Nausea
- Vomiting
- Bloating
- Discomfort in the stomach
- Jaundice (the yellowing of the skin and whites of the eyes)
- Low energy
- Dyspnea (feeling short of breath)
How are Hepatic Hemangiomas diagnosed?
Potential diagnostic measures include:
- Observation of symptoms
- Physical exam
- Blood sample
- Ultrasound
- Imaging (MRI or CT scan)
- Scintigraphy (uses a radioactive tracer material to produce images of the liver)
- Skin biopsy
Patients may need to be admitted to the hospital to undergo the necessary diagnostic measures listed above. This process often involves collaboration among various departments, including hepatology, surgery, nursing, social work and dietetics to ensure comprehensive care.
How are Hepatic Hemangiomas treated?
Observations (also known as watchful waiting)
Most hemangiomas shrink or go away on their own without treatment. Your doctor will monitor your child’s liver regularly to see if the tumor is shrinking.
Propranolol
For IHH, the medicine propranolol is often prescribed in a pill or liquid form. This treatment helps shrink the tumor and reduce its growth.
Laser therapy
In some cases, a laser treatment can help reduce the size of the hemangioma, especially if it is causing problems on the skin.
Surgery and other treatments
In severe cases, surgery may be needed to remove the hemangioma. For larger or more complicated tumors, treatments like embolization (blocking blood flow to the tumor) or radiofrequency ablation (using heat to shrink the tumor) might be used.
What happens next?
- Your child will need periodic ultrasounds or MRI scans to monitor the size of the hemangioma.
- Contact your doctor if your child shows signs of abdominal pain, swelling or breathing issues.
- If needed, propranolol may be prescribed to help shrink the tumor. For larger or problematic tumors, laser therapy, embolization, or surgery may be required.
- Once the tumor shrinks or is treated, most children lead normal, healthy lives with no ongoing issues. In rare cases, ongoing monitoring may be required until the liver is fully healed.
- While the condition can be worrying for parents, with proper care and monitoring, most children with hemangiomas lead healthy, active lives.
Can Hepatic Hemangiomas be prevented?
There is no known way to prevent hepatic hemangiomas because their exact cause is not well understood. Since they are often diagnosed in newborns or infants, early detection through regular doctor visits can help manage any issues that arise.
