Search

Purpose: To evaluate the safety, efficacy, and long-term outcomes of transarterial chemoembolization (TACE) with bleomycin-Lipiodol for giant liver hemangiomas. Materials and Methods: Single-center retrospective study from 1998 to January 2020, including patients with giant liver hemangiomas treated with bleomycin-Lipiodol TACE and followed up >36 months. The exclusion criteria were defined as patients who had been treated but had no available follow-up above 3 years and patients who had previously been treated with any other treatment method. Clinical success was defined as the disappearance of symptoms and radiological success (responded vs. non-responded groups) as a more than 50% decrease in the volume of the giant hemangioma in follow-up CT or MRI compared to the baseline images. Results: A total of 121 patients were included. The mean maximum diameter of the hemangiomas decreased from 122 (range: 40–300) to 73 mm (range: 15–240), and the mean volume reduced from 984.4 (range: 30–7312) to 286.6 cm3 (range: 1–3835). There were 106 patients in the responded group, while only 15 patients were in the non-responded group. No significant difference was found in size and volume change percentages across these two groups based on gender, age, lesion size, lesion volume, lesion number, and second TACE. When the follow-up period was stratified in 5-year periods, the maximum volume decrease was observed in the first 5-year period and then remained constant up to > 15 years. Conclusion: TACE with bleomycin-Lipiodol is safe, reducing the size and volume of giant liver hemangiomas with stable results in the long-term follow-up. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Giant pedunculated hepatic hemangiomas, mostly seen in women, are considered a rare type of giant hepatic hemangioma, with challenging diagnosis. Unlike other types of liver hemangiomas, they can manifest different kinds of symptoms, and are prone to life‐threatening manifestations like rupture or torsion. Hemangioma is the most common benign liver primary tumor. Hepatic hemangioma >4 cm (some studies suggest >10 cm) is referred to as a giant hemangioma. Although hepatic hemangioma does not manifest symptoms in most cases, a giant hepatic hemangioma can manifest different kinds of symptoms. Giant pedunculated hepatic hemangiomas are considered a rare type of giant hepatic hemangioma, with challenging diagnosis, as the thin pedicle could be hard to be detected on imaging. A 41‐year‐old woman was admitted to our hospital, with dull discomfort of the right upper quadrant and epigastric region and early satiety for the past 7 months, with the history of taking oral contraceptive (OCP) for 10 years. Ultrasound and computed tomography revealed a 130 × 124 × 76 mm solid mass, with central cystic lesion, located in the midline of the epigastric region, attaching to the inferior surface of the third segment of the left lobe of the liver. Due to the potential risk for torsion, and rupture of the hemangioma, the management of the patient proceeded to surgical excision. Pathological examination of the specimen confirmed the diagnosis of hepatic hemangioma. Giant pedunculated hepatic hemangioma is a rare benign tumor. It demonstrates higher incidence rate in women, as some hemangiomas have estrogen receptors, and estrogen can lead to endothelial cell proliferation and organization in vascular structure. Most hemangiomas do not express any symptoms; therefore, no treatment is needed except for the patients who manifest symptoms, or in giant pedunculated hemangiomas, as they are prone to rupture or torsion. In this review most cases were female, and most of them presented with abdominal pain, in most cases the tumor located in the left lobe of the liver. Almost all the reviewed cases underwent surgery. Giant hepatic hemangioma is a differential diagnosis of palpable mass, or other symptoms of the right upper quadrant, and epigastric region specially in women taking OCP. Imaging is needed to rule out these tumors, and most often, pedunculated hemangioma is harder to be defined on imaging. It requires surgery because of the risk of acute problems, such as torsion and rupture. [ABSTRACT FROM AUTHOR]

Hemangiomas are most common benign liver tumor. Most patients have an excellent prognosis because of the small size and benign nature of tumor. On some occasions, giant liver hemangioma may cause symptoms and significant challenges due to its complication. We report a case of giant liver hemangioma treated with minimal invasive approach by transarterial embolization (TAE). Following three TAE sessions over a specific timeframe, the patient was successfully managed, addressing that TAE may be a useful alternative to hepatic surgery in such cases. [ABSTRACT FROM AUTHOR]

Abstract Background Pulmonary arteriovenous fistula (PAVF) is a rare disease, which can lead to the direct return of unoxidized venous blood to pulmonary veins and left heart, resulting in right-to-left shunt leading to hypoxia. Long term, the right-to-left shunt will cause severe pathophysiological changes in the patient’s body and pulmonary circulation, and the prognosis will be poor if PAVF is not treated timely. Case presentation Here, we report the case of a 71-year-old man who presented with chest tightness and shortness of breath. After a series of examinations, PAVF and giant hemangioma were diagnosed, which are difficult to operate.Transcatheter interventional therapy was initiated. The patient recovered on the third day after operation and was discharged smoothly. During the long-term follow-up of nearly 4 years after discharge, the general condition and quality of life of the patient basically returned to normal. Conclusions PAVF is rare but very important clinical problem. When the clinical manifestations of persistent unexplained hypoxia appear, it is necessary to fully consider the possibility of PAVF. Once the diagnosis of PAVF is clear, timely treatment is recommended to avoid deterioration of the disease and affecting the prognosis.

Key Clinical Message Giant pedunculated hepatic hemangiomas, mostly seen in women, are considered a rare type of giant hepatic hemangioma, with challenging diagnosis. Unlike other types of liver hemangiomas, they can manifest different kinds of symptoms, and are prone to life‐threatening manifestations like rupture or torsion. Abstract Hemangioma is the most common benign liver primary tumor. Hepatic hemangioma >4 cm (some studies suggest >10 cm) is referred to as a giant hemangioma. Although hepatic hemangioma does not manifest symptoms in most cases, a giant hepatic hemangioma can manifest different kinds of symptoms. Giant pedunculated hepatic hemangiomas are considered a rare type of giant hepatic hemangioma, with challenging diagnosis, as the thin pedicle could be hard to be detected on imaging. A 41‐year‐old woman was admitted to our hospital, with dull discomfort of the right upper quadrant and epigastric region and early satiety for the past 7 months, with the history of taking oral contraceptive (OCP) for 10 years. Ultrasound and computed tomography revealed a 130 × 124 × 76 mm solid mass, with central cystic lesion, located in the midline of the epigastric region, attaching to the inferior surface of the third segment of the left lobe of the liver. Due to the potential risk for torsion, and rupture of the hemangioma, the management of the patient proceeded to surgical excision. Pathological examination of the specimen confirmed the diagnosis of hepatic hemangioma. Giant pedunculated hepatic hemangioma is a rare benign tumor. It demonstrates higher incidence rate in women, as some hemangiomas have estrogen receptors, and estrogen can lead to endothelial cell proliferation and organization in vascular structure. Most hemangiomas do not express any symptoms; therefore, no treatment is needed except for the patients who manifest symptoms, or in giant pedunculated hemangiomas, as they are prone to rupture or torsion. In this review most cases were female, and most of them presented with abdominal pain, in most cases the tumor located in the left lobe of the liver. Almost all the reviewed cases underwent surgery. Giant hepatic hemangioma is a differential diagnosis of palpable mass, or other symptoms of the right upper quadrant, and epigastric region specially in women taking OCP. Imaging is needed to rule out these tumors, and most often, pedunculated hemangioma is harder to be defined on imaging. It requires surgery because of the risk of acute problems, such as torsion and rupture.

The Kasabach–Merritt syndrome (KMS) is characterized by the occurrence of hemangioendothelioma (giant hemangioma with thrombosis leading to thrombocytopenia), which can be associated with disseminated intravasal coagulation. Specific aim: Based on (i) selective references from the current scientific literature and derived recommendations as well as (ii) own experiences obtained in the diagnostic and perioperative management of a representative case from daily practice in abdominal surgery, the specific case undergoing elective cholecystectomy (CCE) in KMS is to be described by means of scientific case report.

Hepatic hemangiomas are common benign liver tumors. While the majority are small and require no treatment, giant hemangiomas are characterized as measuring greater than 4-6 cm in size and may require intervention. Surgical resection and enucleation have been described historically as the treatment for giant hemangiomas requiring intervention. Additionally, limited data exists about the treatment of hemangiomas measuring greater than 20 cm, particularly in regards to transarterial chemoembolization. We present a case of a super-giant hemangioma measuring greater than 20 cm treated with transarterial chemoembolization alone.

Amaç: Bu retrospektif gözlemsel çalışmanın amacı, karaciğer dev hemanjiyomlarının tedavisinde uygulanan bleomisin ve lipiodol karışımı ile transarteryal kemoembolizasyon (TAKE) tedavisinin güvenilirliğini ve etkinliğini değerlendirmekti. Gereç ve Yöntem: Bu çalışmaya Ekim 2014 ile Ocak 2020 tarihleri arasında bleomisin ve lipiodol karışımı ile TAKE uygulanan ve takip edilen 24 dev hemanjiyomu olan ardışık 21 hasta dahil edilmiştir. Tüm hastaların işlem öncesi ve sonrası dev hemanjiyom boyutları, hacimleri, bası bulguları not edilmiştir.. Bulgular: Bu çalışmada tedavi uygulanmış toplam 24 hemanjiyomu olan 21 hasta (14’ü [%66.6] kadın) istatistiksel olarak değerlendirilmiştir. Hastaların medyan yaşı 47’dir (min-max: 35-69 yaş). Hastaların TAKE sonrası medyan takip süresi, 26.2 aydır (min-max: 5.5-48.5 ay). İki hasta dışında tüm hastalara tek seans TAKE uygulandı. Dev hemanjiyomların medyan boyutu, TAKE öncesi 96 mm (min-max: 41-210 mm), TAKE sonrası 61 mm’dir (min-max: 20-120 mm). Dev hemanjiyomların TAKE öncesi medyan hacmi 240.79 ml (min-max: 13.13-2628.62 ml); TAKE sonrası 61 ml’dir (min-max: 3.02-831.16 ml). Hem boyut hem de hacimsel azalma istatistiksel olarak anlamlı bulundu. Herhangi bir majör komplikasyon gözlemlenmedi Sonuç: Bleomisin ve lipiodol karışımı ile TAKE düşük komplikasyon oranı nedeniyle güvenilir bir yöntemdir. Dev hemanjiyomlarda anlamlı ölçüde küçülme sağlaması nedeniyle, etkin bir yöntemdir. Cerrahi tedavinin uygun olmadığı dev hemanjiyomlu hastalarda alternatif olabilir.

Hemangioma can be misdiagnosed. In our case the lesion was suggestive of a melanoma of the leg in a young patient. Indeed, the location of hemangioma in the limb is extremely rare and the and the literature most often reports the location of the upper limb. The largest hemangioma described was 10 cm in diameter In our patient, the size was 5.5x5 cm which makes our case interesting. In our case, the appearance, location and evolutionary history of the lesion were mistaken for a melanoma. Cavernous hemangioma is a rare, malformation that is difficult to diagnose. It is most of deep localization, namely the nervous system, the bone and the muscle. We report a case of a giant hemangioma of the leg mimicking a melanoma. [ABSTRACT FROM AUTHOR]

Large benign hepatic masses as a rare indication for liver transplantation have been reported less frequently. These liver transplantations are complex, with high intraoperative bleeding, high perioperative complication rates, and high mortality rates due to difficulties in visualization, especially when they have undergone various percutaneous operations or open surgery, resulting in severe perihepatic adhesions. Here is a case report of a patient admitted to our hospital who underwent liver transplantation after suffering from a giant hemangioma in liver transplantation for 10 years and who had received multiple interventional treatments ineffective in the past.

We report a case of hepatic hemangiomatosis coexistent with a giant hepatic hemangioma diagnosed in the context of the study for SARS-CoV-2 infection. Computed tomography showed irregular contours of the left hepatic lobe with a lesion that compromised the whole lobe, with peripheral uptake and a centripetal tendency in the late phase, compatible with bulky cavernous hemangioma, as well as another lesion with the same characteristics in segment VI. Magnetic resonance imaging of the abdomen showed multiple hepatic hemangiomas observed in both lobes involving all segments, some of them smaller than 1 cm, which were hyperintense in the T2-weighted sequences and showed progressive contrast enhancement. This case illustrates the incidental diagnosis of this condition during the study for another pathology, the radiological features that are important to differentiate from other tumoral findings, and the possible management strategies to follow.

Teaching Point: Although frequent, the coexistence of diffuse hepatic hemangiomatosis (DHH) with giant cavernous hemangioma (GCH) should be mentioned clearly and communicated to the referring physician for an appropriate management.

Purpose: The aim of this retrospective observational study was to evaluate the safety and efficacy of transarterial chemoembolization (TACE) therapy with a mixture of bleomycin and lipiodol used in the treatment of giant liver hemangiomas. Materials and Methods: Twenty-one patients with a total of 24 giant liver hemangiomas treated with TACE using a mixture of bleomycin and lipiodol between October 2014 to January 2020 were included in this study. Dimension, volume, and compression findings prior to and after the procedure were recorded.. Results: Twenty-four hemangiomas in 21 patients (14 [66,6%] female) were statistically investigated. The median age was 47 years (min-max: 35-69 years). Post-TACE median follow-up was 26.2 months (min-max: 5.5-48.5 months). In all but two patients, a single session TACE was performed. The median dimension of giant hemangiomas was 96 mm (min-max: 41-120 mm) and 61 ml (min-max: 20-120 mm) before and after TACE respectively. Median volume was 240.79 ml (13.13-2628.62 ml) and 61 ml (3.02-831.16 ml) before and after TACE respectively. There was a statistically significant reduction in both dimension and volume. There was no major complication. Conclusion: Transarterial chemoembolization with a mixture of bleomycin and lipiodol is a safe method due to the low complication rate. Due to the fact that it significantly reduces the size of giant hemangiomas, it is an effective method. It may be an alternative in patients with giant hemangioma for whom surgical treatment is not appropriate. [ABSTRACT FROM AUTHOR]

Teaching Point: Although frequent, the coexistence of diffuse hepatic hemangiomatosis (DHH) with giant cavernous hemangioma (GCH) should be mentioned clearly and communicated to the referring physician for an appropriate management. [ABSTRACT FROM AUTHOR]

A hepatic hemangioma is a benign liver tumor made up of a number of blood-filled chambers surrounded by liver-supplied endothelial cells. Most liver hemangiomas are asymptomatic and are only discovered during imaging studies for other conditions. Ultrasound is used for initial screening followed by a computed tomography scan, which shows slow enhancement due to small vessels and can be used to diagnose the location, number, and size of a hepatic hemangioma. A large liver hemangioma can range in size from 10 centimeters to more than 20 centimeters and can cause symptoms and complications that require prompt intervention. Hepatic hemangiomas can co-occur with other localized hepatic lesions; a careful diagnosis is necessary to distinguish them. In this case study, a 48-year-old woman complained of a stomachache that had persisted for three months. Following an initial clinical evaluation, hepatomegaly was found, and contrast-enhanced computed tomography (CECT) abdomen and pelvis was performed, revealing numerous giant hepatic hemangiomas. Significant improvements were noted in the patient's condition with tumor embolization., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Gopalan et al.)

Laryngeal hemangiomas are rare vascular tumors, mainly in children, and less common in adults. Giant lesions typically require multiple endoscopic procedures and temporary tracheostomy. Open surgery allows single-procedure removal with fewer complications. CO 2 laser excision controls bleeding and minimizes tissue damage. This study evaluates this hybrid approach to manage adult giant supraglottic hemangiomas. A 54-year-old woman with a giant supraglottic hemangioma was successfully treated using a combination of open surgery and CO 2 laser. Limited data on adult laryngeal hemangiomas result in a lack of established treatment protocols. For giant supraglottic hemangiomas, combining open surgery with CO 2 laser resection offers distinct advantages: enhanced lesion visibility, optimal airway control, effective hemostasis, reduced tissue damage, and lower recurrence rates. This hybrid approach also supports rapid recovery and favorable clinical outcomes. Combining open surgical excision with CO 2 laser is effective for managing giant supraglottic hemangiomas in adults., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Abstract Background Performing laparoscopic liver resection for giant hemangiomas is challenging, and careful preoperative planning is essential. Controlling intraoperative bleeding and handling surgical instruments within a limited workspace is necessary. Case presentation In the present case, the patient was a 38-year-old woman diagnosed with a 16-cm giant liver hemangioma in segment 5/6, with extrahepatic growth. Preoperative three-dimensional simulations for port placement and the laparoscopic view from the left upper abdomen were performed to complete the pure laparoscopic liver resection. The laparoscopic resection was then safely performed on the same way. Conclusions Pure laparoscopic resection could be applied to giant hemangiomas with extrahepatic growth, and the preoperative three-dimensional simulation of port placement and the laparoscopic view might be helpful when the intraabdominal workplace is restricted.

A 50-year-old man without medical history, complained about effort dyspnea with enlargement of the abdomen. Physical examination showed an enlarged liver reaching the right and the left iliac fossa with a collateral venous circulation. Biological exams were within normal ranges. Hepatitis B and C serologies were negative. Abdominal computed tomography and magnetic resonance imaging demonstrated an enlarged liver with a 36 cm in diameter. Multiple bilateral liver masses heterogenous with an enhancement after contrast intravenous injection were shown. The largest one was located in the left liver with 26 cm in diameter. A dense collateral venous circulation existed. A diagnostic percutaneous biopsy was made. Histopathological exam concluded to giant cavernous cavernoma. Since the surgery was risky especially hemorrhage, a percutaneous embolization for the largest mass was indicated.

Hemangioma is the most common benign tumor affecting the liver. The vast majority of liver hemangiomas (LH) are less than 30 mm in diameter, asymptomatic, and are most often identified incidentally during radiological investigations for other reasons. Giant LH greater than 50 mm can lead to the development of symptoms and complications that require prompt surgical intervention. Herein, we report the case of a 58-year-old man who presented with gastric outlet obstruction and obstructive jaundice as a result of a giant hepatic hemangioma that was complicated with fatal spontaneous rupture.

Haemangioma is the most common benign tumour of the liver. However, an exophytic hepatic haemangioma, especially the pedunculated form, is very rare. Giant pedunculated haemangiomas are prone to complications because of the narrow size of the pedicle. A large number of lesions can potentially present as exophytic liver masses, and accurate diagnosis can sometimes be challenging. We report a case of an incidentally discovered asymptomatic giant pedunculated liver haemangioma in the region of the lesser sac in a prospective renal donor, which was initially suspected to be a gastrointestinal stromal tumour of the stomach wall. Multiphasic computed tomography and confirmatory magnetic resonance imaging scans ultimately revealed the true nature of the lesion, which turned out to be an exophytic pedunculated hepatic haemangioma from the left lobe of the liver. The lesion was then surgically resected and histopathologically confirmed to be a haemangioma. The patient subsequently underwent successful renal donation as planned. Being a benign lesion with characteristic imaging features, accurate radiological diagnosis is absolutely essential for the appropriate management of such atypical haemangiomas.

The article presents a case study of 85-year-old man with bronchiectasis diagnosed 50 years prior without interval follow-up presented with dyspnea. It mentions Subsequent contrast-enhanced computed tomography of the chest with delayed phase imaging demonstrated findings characteristic of a giant hemangioma.

Hemangiomas are the most frequent proliferations in children, and liver hemangiomas are the most common among those in the viscera. Early diagnosis to focus treatment is important. We present the case of a neonate with compromised breathing secondary to the effect of a giant mass that echographically appeared to be a hepatic hemangioma. Surgical resection and subsequent pathology confirmed the diagnosis. [ABSTRACT FROM AUTHOR]

The cavernous hemangiomas of the liver are usually small sized and asymptomatic. Most of them are incidentally diagnosed and a very small portion requires therapy. Giant hemangioma can be symptomatic, and this condition is the indication for treatment. The striking complication of surgical treatment of cavernous hemangiomas is intra-operative bleeding. In this case, we aimed to demonstrate that the risk of intraoperative bleeding can be eliminated with the preoperative percutaneous trans-catheter arterial embolization technique.

This case report relates the use of contrast-enhanced ultrasound (CEUS) for the assessment and treatment of a postinterventional cholecystitis, a rare but important complication after transcatheter arterial embolization of a giant hemangioma. Regarding the imaging diagnosis, hemangiomas have specific features allowing a fast recognition by all radiological modalities,and in recent years, especially by CEUS. [ABSTRACT FROM AUTHOR]

Hemangiomas are the most common benign primary hepatic neoplasms, often being incidentally discovered. In most of the cases they are small and asymptomatic. It is widely accepted that clinical intervention is indicated only for symptomatic hemangiomas. We present a case of an asymptomatic giant hemangioma managed by enucleation due to its atypical localization. The hemangioma, originally located in segment 5, was now described in Computer Tomography (CT) Imaging as separating the gallbladder from the liver parenchyma. A careful evaluation of images revealed proximity to the portal vein (PV), right hepatic artery (RHA), right hepatic duct (RHD) and right branch of the portal vein (RBPV). Thus, in the case of an emergent operation, surgical maneuvers in the area of the altered hepatic anatomy and proximity to the hemangioma itself, would in fact increase the risk endangering the patient's life. After patient's consent, a surgical enucleation en block with the gall-bladder was performed. It is of great importance that specifically selected, asymptomatic patients diagnosed with a giant hemangioma, with the above mentioned or similar localization should be considered for surgical treatment. [ABSTRACT FROM AUTHOR]

Purpose: This study was designed to explore the safety and efficacy of percutaneous microwave (MW) ablation as an alternative treatment for symptomatic giant hepatic hemangiomas. Methods: Patients ( n = 7; 6 females, 1 male; mean age = 44 years) with symptomatic, giant hemangiomas ( n = 8) were treated with ultrasound-guided percutaneous MW ablation and followed for a mean of 18 months. Patient pain was recorded both before and after the procedure according to the 10-point visual analog scale. All patients were treated using one or three gas-cooled 17-gauge antennas powered by a 2.4-GHz generator (Neuwave Medical, Madison, WI). Mean ablation time was 11.6 min. Four patients received hydrodissection to protect the abdominal wall, colon, or gallbladder (5 % dextrose in water, mean volume 900 mL). Immediate postablation biphasic CT of the abdomen was performed, and four of seven patients have undergone delayed follow-up imaging. Results: All ablations were technically successful with no major or minor complications. Average pain score decreased from 4.6 to 0.9 ( p < 0.05), and six of seven patients report resolution or improvement of symptoms at 18-month average follow-up (range 1-33 months). Immediately postablation, mean tumor diameter decreased 25 % (from 7.3 to 5.5 cm, p < 0.05) and volume decreased 62 % (from 301 to 113 cm, p < 0.05). Discussion: In this series, percutaneous MW ablation was safe, well-tolerated, and effective in markedly shrinking large hepatic hemangiomas and improving symptoms in most patients. [ABSTRACT FROM AUTHOR]