University of Texas Rio Grande Valley at Doctors Hospital at Renaissance Edinburg, TX, United States
Lyla Saeed, MD1, Nghia Nguyen, DO, MS1, Grigoriy Rapoport, MD2, Asif Zamir, MD, FACG1, Juan Castano, MD1 1University of Texas Rio Grande Valley at Doctors Hospital at Renaissance, Edinburg, TX; 2University of Texas Rio Grande Valley at Doctor's Hospital at Renaissance, Edinburg, TX
Introduction: Hepatic hemangiomas (HHs) arise from vascular malformations and are the most common benign liver tumors. Incidence is estimated to be between 1 and 5% in the United States. Majority of HH are small and asymptomatic. The following is a rare case of giant HHs causing abdominal pain.
Case Description/Methods: A 45-year-old woman with a history of GERD, hypertension and dyslipidemia, complaining of burning RUQ pain and intermittent nausea and vomiting, presented to clinic for evaluation of HHs discovered on MRI imaging in an outside facility. Two embolization attempts were unsuccessful. Liver enzymes were unremarkable. Contrast CT revealed a large mass in the caudate lobe measuring 16.3 x 9 cm and another mass in the posterior segment right lobe measuring 7.2 x 8.2 cm. Both lesions were nearly iso-dense to the liver on pre-contrast and demonstrated peripheral pulling of contrast in a pattern consistent with HHs. Hepatectomy of the caudate lobe and the left lateral segment of the liver were performed. Due to the grossly fatty appearance of the liver, only the superficial part of the right lobe HH was resected to preserve liver function. The patient remained asymptomatic during follow-up.
Discussion: Risk factors for HHs include age between 30 and 50, female, pregnancy and use of hormone replacement therapy. Most HHs are diagnosed incidentally on imaging, since they are usually small and asymptomatic. In rare cases HHs can grow to more than 10 cm and are classified as “giant.” Symptoms caused by these lesions include RUQ pain, early satiety, nausea and vomiting. Management of HHs depends on size and location of the tumors. Small and asymptomatic HHs do not require treatment. Surveillance imaging studies are recommended for tumors larger than 5 cm because of high risks of rupture, compression against surrounding organs and bleeding. Giant HHs that exhibit rapid growth or are symptomatic require definite interventions. Surgical resection remains the treatment of choice. Other treatment options include transcatheter arterial embolization, ablation, radiation and rarely, liver transplant.
Figure: Contrast CT abdomen revealed a large mass in the caudate lobe measuring 16.3 x 9 cm. The lesion was nearly iso-dense to the liver on pre-contrast and demonstrated peripheral pulling of contrast in a pattern consistent with HHs.
Disclosures: Lyla Saeed indicated no relevant financial relationships. Nghia Nguyen indicated no relevant financial relationships. Grigoriy Rapoport indicated no relevant financial relationships. Asif Zamir indicated no relevant financial relationships. Juan Castano indicated no relevant financial relationships.
Lyla Saeed, MD1, Nghia Nguyen, DO, MS1, Grigoriy Rapoport, MD2, Asif Zamir, MD, FACG1, Juan Castano, MD1. P1846 - A Rare Case of Giant Hepatic Hemangiomas, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.
