Congenital hepatic hemangioma
- Etiology: Vascular benign endothelial channels of varying size with fibrosis
- Imaging CXR: Extracardiac left to right shunt leads to acyanosis and increased pulmonary blood flow
- Imaging:
— Solitary, large, heterogenous lesion
— Big vessels with shunting
— Broadening peripheral enhancement, not central enhancement
— Can have calcification - DDX: Hepatic adenoma, focal nodular hyperplasia
- Complications:
- Treatment:
- Clinical:
— May have an associated cutaneous lesion
— Presents prenatally or at birth
— Less common hemangioma (30%)
— Equal male and female prevalence
— Growth is complete at birth or grows proportionately with the child’s growth
— Rapidly involuting (RICH) and non-involuting (NICH), RICH tumor regresses by 18-24 months
— Does not need tissue sampling
— Heart failure and mild anemia and thrombocytopenia
— Neonatal AFP levels
— GLUT-1 negative - Note: Beware of this diagnosis if seen after first week of life, rising or steadily elevated AFP, increasing in size
Infantile hepatic hemangioma
- Etiology: Vascular benign neoplasm of capillaries
- Imaging:
— Focal or multifocal or diffuse
— Small to moderate in size and homogenous lesion
— With or without vascularity and AV shunting
— Early peripheral to delayed central enhancement with centripetal fill in - DDX: Hepatic adenoma, focal nodular hyperplasia
- Complications:
- Treatment: Propranolol or steroids
- Clinical:
— Characteristic cutaneous appearance
— Develops within weeks – months
— More common hemangioma (70%)
— Female prevalence (5:1)
— Grows rapidly for approximately 6-12 months followed by slow involution (over 5-9 years) with 90% regressing by 9 years
— GLUT-1 positive
— Most common liver tumor in children - Note: Beware this diagnosis if there are atypical or no cutaneous lesions, a dominant hepatic lesion or other abdominal masses
Radiology Cases of Congenital Hepatic Hemangioma
