Pediatric Hepatic Hemangioma

Congenital hepatic hemangioma

  • Etiology: vascular, benign endothelial channels of varying size with fibrosis
  • Imaging: solitary, large, heterogenous, big vessels with shunting, broadening peripheral enhancement, not central enhancement, can have calcification
  • DDX:
  • Complications:
  • Treatment:
  • Clinical: may have an associated cutaneous lesion, present 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 / mild anemia + 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 size

Infantile hepatic hemangioma

  • Etiology: vascular, benign neoplasm of capillaries
  • Imaging: focal or multifocal or diffuse, small to moderate, homogenous, +/- vascularity / AV shunting, early peripheral to delayed central enhancement with centripetal fill in
  • DDX:
  • 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), 90% regress by 9 years, GLUT-1 positive
  • 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

MRI of liver hemangioma
Coronal T1 weighted MRI without (left) and with (right) contrast of the abdomen shows a round, well-circumscribed lesion in the right lobe of the liver that has ring enhancement and that was seen to fill in on delayed images.
CT of liver hemangioma
Axial CT with contrast of the abdomen in the arterial phase (upper left) and then 1, 7 and 15 minutes later (lower right) shows a large liver mass that has an enhancing rim and a low density center which slowly filled in on delayed images.

Radiology Cases of Infantile Hepatic Hemangioma