• PIVKA-II
• coagulation disorders
• hepatic hemangioma
• prothrombin

• Humans
• Hemangioma/blood
• Hemangioma/pathology
• Male
• Female
• Middle Aged
• Liver Neoplasms/blood
• Liver Neoplasms/pathology
• Protein Precursors/blood
• Adult
• Biomarkers/blood
• Aged
• Prothrombin/metabolism
• Blood Coagulation Factors/metabolism
• Vitamin K
• Blood Proteins/metabolism

• atypical hepatic hemangioma
• computed tomography (CT)
• contrast-enhanced ultrasound (CEUS)
• hepatic hemangiomas
• magnetic resonance (MR)
• transarterial chemoembolization (TACE)
• ultrasound (US)

• Humans
• Liver Neoplasms/diagnostic imaging
• Liver Neoplasms/therapy
• Liver Neoplasms/pathology
• Carcinoma, Hepatocellular/therapy
• Magnetic Resonance Imaging/methods
• Chemoembolization, Therapeutic
• Hemangioma/diagnostic imaging
• Hemangioma/therapy
• Hemangioma, Cavernous/diagnostic imaging
• Hemangioma, Cavernous/therapy

• bleomycin–lipiodol emulsion
• giant hepatic hemangioma
• interventional radiology
• liver tumor treatment
• transcatheter arterial chemoembolization (TACE)

• Arteriovenous malformation
• Hemangioma
• Liver
• Surgery

• Humans
• Retrospective Studies
• Case-Control Studies
• Liver Neoplasms/surgery
• Liver Neoplasms/diagnosis
• Hemangioma/surgery
• Hemangioma/diagnosis
• Tumor Burden
• Treatment Outcome

• coagulation disorder
• hepatic hemangioma
• liver fibrosis
• management
• natural history

• bleomycin
• giant hepatic hemangiomas
• lipiodol
• transarterial bleomycin–lipiodol embolization
• transarterial chemoembolization (TACE)

• Humans
• Female
• Male
• Middle Aged
• Ethiodized Oil/therapeutic use
• Carcinoma, Hepatocellular/therapy
• Feasibility Studies
• Retrospective Studies
• Liver Neoplasms/therapy
• Chemoembolization, Therapeutic/adverse effects
• Aortic Dissection
• Bleomycin/adverse effects
• Hemangioma
• Syndrome

• Benign
• Liver tumor
• Microwave ablation
• Radiofrequency ablation

• Complications
• Diagnostics
• Malignancy
• Treatment
• Treatment pathways

• Focal liver lesion
• Focal nodular hyperplasia
• Hepatic hemangioma
• Hepatocellular adenoma

• Humans
• Digestive System Diseases
• Abdomen
• Liver Neoplasms/diagnosis
• Italy

• Complicated hepatic cyst
• Focal liver lesion
• Parasitic hepatic cyst
• Polycystic liver disease
• Simple hepatic cyst

• Humans
• Digestive System Diseases
• Abdomen
• Cysts/diagnostic imaging
• Cysts/therapy
• Liver Neoplasms/diagnostic imaging
• Italy

• fever of unknown origin (FUO)
• giant hepatic cavernous hemangioma
• hepatectomy

• Female
• Hemangioma/complications
• Hemangioma/diagnostic imaging
• Hemangioma/surgery
• Hemangioma, Cavernous/complications
• Hemangioma, Cavernous/diagnostic imaging
• Hemangioma, Cavernous/surgery
• Hepatectomy
• Humans
• Liver Neoplasms/complications
• Liver Neoplasms/diagnostic imaging
• Liver Neoplasms/surgery
• Middle Aged

Hepatic hemangiomas are the most common benign tumors found in the liver. Herein, we present a case of a giant hepatic hemangioma (>4 cm) complicated by bilateral pulmonary embolism originating from the inferior vena cava thrombus with clinical and radiological features of portal hypertension. A 52-year-old woman presented to the emergency department of our institution with a history of blackouts. She underwent an extensive workup for potential causes of syncope, and a massive bilateral pulmonary embolism was detected. On examination, the patient was conscious, and her vital signs were within normal ranges. Abdominal examination revealed massive ascites and irregular nodular hepatomegaly without splenomegaly. Laboratory test results revealed normal liver function. The patient had elevated D-dimer levels. The serum-ascites albumin gradient was not elevated. Tumor marker levels were all within the normal range, and autoimmune profile results and test results for thrombophilia markers were negative. Abdominopelvic CT demonstrated hepatomegaly and a giant fungating chronic hepatic hemangioma occupying the right lobe along with an infrarenal inferior vena cava thrombus. The patient was discharged and prescribed a therapeutic dose of enoxaparin and diuretics. As the patient was not a candidate for resection due to the large hemangioma size and invasion of the liver tissue, she was referred to another center for a liver transplant. Hepatic hemangiomas are benign lesions and are usually managed conservatively since surgical intervention is controversial and is reserved for symptomatic or complicated cases. With an anatomically challenging lesion, enucleation/resection could not be achieved, and liver transplantation was the best achievable option.

Hepatic hemangioma is usually detected on a routine ultrasound examination because of silent clinical behaviour. The typical ultrasound appearance of hemangioma is easily recognizable and quickly guides the diagnosis without the need for further investigation. But there is also an entire spectrum of atypical and uncommon ultrasound features and our review comes to detail these particular aspects. An atypical aspect in standard ultrasound leads to the continuation of explorations with an imaging investigation with contrast substance [ultrasound/ computed tomography/or magnetic resonance imaging (MRI)]. For a clinician who practices ultrasound and has an ultrasound system in the room, the easiest, fastest, non-invasive and cost-effective method is contrast enhanced ultrasound (CEUS). Approximately 85% of patients are correctly diagnosed with this method and the patient has the correct diagnosis in about 30 min without fear of malignancy and without waiting for a computer tomography (CT)/MRI appointment. In less than 15% of patients CEUS does not provide a conclusive appearance; thus, CT scan or MRI becomes mandatory and liver biopsy is rarely required. The aim of this updated review is to synthesize the typical and atypical ultrasound aspects of hepatic hemangioma in the adult patient and to propose a fast, non-invasive and cost-effective clinical-ultrasound algorithm for the diagnosis of hepatic hemangioma.

• Hemangioma
• Liver
• Ultrasound
• Contrast media
• Diagnosis
• Algorithm

• Benign liver tumor
• Hepatic adenoma
• Hepatic epithelioid hemangioendothelioma
• Hepatic hemangioma
• Liver adenomatosis
• Liver transplantation

• 3D image reconstruction
• Giant
• Hepatic hemangioma
• Surgical indication
• Surgical management
• Surgical technique

• Echogenicity
• Fluttering sign
• Hepatic hemangioma
• Speckle
• Ultrasound

• Aged
• Contrast Media
• Female
• Hemangioma/diagnostic imaging
• Hemangioma/pathology
• Humans
• Liver Neoplasms/diagnostic imaging
• Liver Neoplasms/pathology
• Male
• Middle Aged
• Retrospective Studies
• Tumor Burden
• Ultrasonography

Little is known concerning causal factors associated with the size and echogenicity of hepatic hemangiomas. The aim of the present study was to investigate the associations between tumor size and echo pattern and coagulation factors, and to elucidate the growth pattern of hemangiomas. In 214 consecutive patients with hepatic hemangiomas, ultrasonography was performed to determine total tumor number, size, echogenicity and location, and serum laboratory tests for liver function and coagulation factors were carried out. The ultrasonographic appearance of hemangiomas was homogeneous in 75.7% of cases and mixed in 24.3% of cases. A mixed echo pattern was seen in 1 out of 145 masses (0.7%) with a diameter <20 mm, in 30 out of 48 (62.5%) with a diameter of 20-40 mm, and in all of the 21 (100%) with a diameter >40 mm. Platelet counts (P<0.0001) and fibrinogen levels (P<0.01) were lower in patients with larger and mixed tumors. Levels of thrombin-antithrombin III complex (TAT), D-dimer, and fibrin and fibrinogen degradation products (FDP) were significantly elevated along with an increase in tumor size (all P<0.0001), and the number of patients with the abnormal values of TAT, D-dimer, and FDP was significantly higher in the mixed group than in the homogeneous group (all P<0.0001). Fibrinogen (P<0.01), platelet count (P<0.001), portal vein diameter (P<0.0001), splenic index (P<0.01), and levels of TAT, D-dimer and FDP (all P<0.0001) were significantly associated with tumor size. Multivariate analysis revealed TAT, D-dimer and FDP as independent predictors of tumor size. The internal echo pattern became mixed as size increased. The size and echogenicity of hemangiomas were closely associated with coagulation factors. Therefore, it was speculated that differences in size and echogenicity were caused by intratumoral thrombosis and subsequent hemorrhage.

• coagulation factors
• hemangiomas
• thrombosis

Hepatic hemangioma (HH) is the most common benign tumor of the liver. In special conditions such as rapidly growing tumors, persistent pain, hemorrhage and when pressure effect on adjacent organs exist treatment is indicated. Surgical management is the most common treatment for HH.

A 38-year-old male patient was diagnosed with HH for 7 years. The initial presentation of the mass was progressive abdominal distention causing early satiety, gastro-esophageal reflux disease, vomiting, dysphagia and weight loss. Later, the patient developed bilateral lower extremity edema. Imaging with computed tomography (CT scan) showed a large mass measuring 32.4*26*3.1 cm which was considered unresectable. The patient underwent a deceased donor liver transplantation. The excised mass was 9 kg. After nine days of hospitalization the patient was discharged in good condition. Three months later, the patient was admitted due to fever and cytomegalovirus infection for which he received intravenous ganciclovir and was discharged. In the latest follow-up the patient had no liver or kidney dysfunction eight months after the transplantation.

With appropriate patient selection, liver transplantation can be considered as a treatment option for patients with huge HHs which are life-threatening and surgically unresectable.

• Benign liver neoplasms
• Cavernous Hemangioma
• Hepatic Hemangioma
• Liver transplantation

• Cirrhosis
• Computed tomography
• Hemangioma
• Liver

To evaluate the clinical efficacy of robotic, laparoscopic, and open hemihepatectomy for giant liver haemangiomas.

From April 2011 to April 2017, consecutive patients who underwent hemihepatectomy for giant liver haemangiomas were included in this study. According to the type of operation, these patients were divided into the robotic hemihepatectomy (RH) group, the laparoscopic hemihepatectomy (LH) group, and the open hemihepatectomy (OH) group. The perioperative and short-term postoperative outcomes were compared among the three groups. The study was reported following the STROCSS criteria.

There were no significant differences in age, sex, tumour location, body surface area (BSA), future liver remnant volume (FLR), standard liver volume (SLV), liver haemangioma volume, FLR/SLV, resected normal liver volume/resected volume, hepatic disease, rates of blood transfusion, liver function after 24 h of surgery, operative morbidity and mortality among the three groups. Compared with patients in the RH group (n = 19) and the LH group (n = 13), patients in the OH group (n = 25) had a significantly longer postoperative hospital stay (P < 0.05), time to oral intake (P < 0.05), and time to get-out-of-bed (P < 0.05); a higher VAS score after 24 h of surgery (P < 0.05); and a shorter operative time (P < 0.05). There were no significant differences in these postoperative outcomes (P>0.05) between the RH group and the LH group. When the setup time in the RH group was excluded, the operative time in the RH group was significantly shorter than that in the LH group (P<0.05). There was no significant difference in the operative time between the RH group and the OH group (P>0.05). The amount of intraoperative blood loss in the RH group was the lowest among the three groups (P<0.05), and the amount of intraoperative blood loss in the LH group was less than that in the OH group (P<0.05).

Robotic and laparoscopic hemihepatectomies were associated with less intraoperative blood loss,better postoperative recovery and lower pain score. Compared with laparoscopic hemihepatectomy, robotic hemihepatectomy was associated with significantly less intraoperative blood loss and a shorter operative time.

• Clinical effects
• Giant liver haemangioma
• Hemihepatectomy
• Laparoscopic liver resection
• Robotic liver resection

• Atypical
• Computed tomography (CT)
• Hepatic hemangioma
• Imaging
• Magnetic resonance (MR)
• Ultrasound (US)

• Diagnosis, Differential
• Hemangioma/complications
• Hemangioma/diagnostic imaging
• Hemangioma/pathology
• Humans
• Liver Neoplasms/complications
• Liver Neoplasms/diagnostic imaging
• Liver Neoplasms/pathology

• Appropriateness
• Choosing wisely
• Overdiagnosis
• Overtreatment
• Recommendations

• Gastroenterologists/organization & administration
• Gastroenterologists/psychology
• Gastroenterologists/standards
• Humans
• Italy
• Medical Errors/prevention & control
• Medical Overuse/prevention & control
• Societies, Medical/organization & administration
• Societies, Medical/trends
• Surveys and Questionnaires

• Hepatic hemangiomatosis

• AKT1 mutation
• Proteus syndrome
• overgrowth syndromes
• vascular malformations

• Bleomycin–lipiodol
• Hepatic hemangioma
• Transarterial bleomycin–lipiodol embolization (B/LE)

Background: The formation of hepatic hemangiomas (HH) is associated with VEGF and IL-7 that alter conduit arteries and small arterioles. To our knowledge, there are no studies to investigate the effects of HH on the hemodynamics in conduit arteries. The aim of the study is to perform morphometric and hemodynamic analysis in abdominal conduit arteries and bifurcations of HH patients and controls.

Methods: Based on morphometry reconstructed from CT images, geometrical models were meshed with prismatic elements for the near wall region and tetrahedral and hexahedral elements for the core region. Simulations were performed for computation of the non-Newtonian blood flow using the Carreau-Yasuda model, based on which multiple hemodynamic parameters were determined.

Results: There was an increase of the lumen size, diameter ratio, and curvature in the abdominal arterial tree of HH patients as compared with controls. This significantly increased the surface area ratio of low time-averaged wall shear stress (i.e., SAR-TAWSS =Surface  areaTAWSS≤4 dynes·cm−2Total  surface  area× 100%) (24.1 ± 7.9 vs. 5 ± 6%, 11.6 ± 12.8 vs. < 0.1%, and 44.5 ± 9.2 vs. 21 ± 24% at hepatic bifurcations, common hepatic arteries, and abdominal aortas, respectively, between HH and control patients).

Conclusions: Morphometric changes caused by HH significantly deteriorated the hemodynamic environment in abdominal conduit arteries and bifurcations, which could be an important risk factor for the incidence and progression of vascular diseases.

• abdominal arterial tree
• computer tomography
• hemodynamics
• hepatic hemangioma
• morphology

• Hepatic hemangiomas. Hepatic surgery. Radiofrequency ablation. Benign tumors of the liver.

Hepatic hemangioma represents the most common benign primary hepatic neoplasm. Although most such tumors are small and asymptomatic, giant hepatic hemangioma is frequently symptomatic, and requires intervention. Moreover, diffuse multiple hepatic hemangiomatosis occupying almost the entire liver is extremely rare in adults, and the optimal management for this condition is unclear. We report a case of a rapidly growing, symptomatic giant hepatic hemangioma with diffuse hepatic hemangiomatosis in a 50-year-old female patient who was treated by living-donor liver transplantation. This case shows malignant behavior of a benign hemangioma that required liver transplantation. Although this case could not meet the criteria for transplantation according to the MELD (model for end-stage liver disease) score system, it should be considered as an exceptional indication for deceased-donor liver allocation. Further studies of the mechanism underlying hemangioma growth are warranted.

• Hemangiomatosis
• Hepatic neoplasm
• Liver transplantation
• Hemangioma

• Benign liver lesions
• Computed tomography
• Imaging
• Magnetic resonance
• Ultrasound

• Cavernous haemangioma
• Iodized oil
• Liver neoplasm
• Pingyangmycin
• Transarterial chemoembolization

This study aimed to determine the feasibility of the extracapsular enucleation method for giant liver hemangiomas by infrahepatic inferior vena cava (IVC) clamping and the Pringle maneuver to control intraoperative bleeding under laparoscopic hepatectomy.

From January 2012 to January 2016, 36 patients underwent laparoscopic extracapsular enucleation of giant liver hemangiomas. Patients were divided into two groups: infrahepatic IVC clamping + Pringle maneuvers group (IVCP group, n = 15) and the Pringle maneuvers group (Pringle group, n = 21). Operative parameters, postoperative laboratory tests, and morbidity and mortality were analyzed.

The mean size of liver hemangiomas was 13.3 cm (range 10–25 cm). Infrahepatic IVC clamping + the Pringle maneuvers with laparoscopic extracapsular enucleation significantly reduced intraoperative blood loss (586.7 vs 315.3 mL, p < 0.001) and transfusion rates (23.8 vs 6.7%, p = 0.001), compared with the Pringle maneuver alone. The gallbladder was retained in both groups. The mean arterial pressure (MAP) in Pringle group remained virtually stable before and after clamping of hepatic portal, while it was significantly decreased after IVC clamping in IVCP group than that pre-clamping (p < 0.001). The heart rate of all patients was significantly increased after clamping when compared to pre-clamping heart rates (p < 0.001). Once vascular occlusion was released, MAP returned to normal levels within a few minutes. There were no significant differences in postoperative complications between two groups. The vascular occlusion techniques in both groups had no serious effect on postoperative of hepatic and renal function.

Extracapsular enucleation with infrahepatic IVC clamping + the Pringle maneuver is a safe and effective surgical treatment to control bleeding for giant liver hemangiomas in laparoscopic hepatectomy.

• Bleeding control
• Extracapsular enucleations
• Giant liver hemangiomas
• Inferior vena cava clamping
• Laparoscopic hepatectomy
• The Pringle maneuvers

• Anti-angiogenesis
• Hepatic hemangioma
• Metformin
• mTORC1–VEGF pathway

• Gastrointestinal
• Genitourinary
• Hemangioma
• Imaging
• Liver
• Spleen

• Gastrointestinal Neoplasms/diagnosis
• Hemangioma/diagnosis
• Humans
• Liver Neoplasms
• Magnetic Resonance Imaging
• Tomography, X-Ray Computed
• Ultrasonography
• Urogenital Neoplasms/diagnosis

• growth pattern
• hepatic hemangioma
• natural history
• surgical indication

• Hepatic haemangioma
• Risk of rupture
• Treatment

• Adult
• Aged
• Cross-Sectional Studies
• Databases, Factual
• Female
• Hemangioma/diagnostic imaging
• Hemangioma/epidemiology
• Humans
• Incidental Findings
• Italy/epidemiology
• Liver Neoplasms/diagnostic imaging
• Liver Neoplasms/epidemiology
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Prevalence
• Retrospective Studies
• Rupture, Spontaneous/epidemiology
• Tomography, X-Ray Computed

The aim of the study was to determine the sonographic prevalence of benign focal liver lesions on the basis of a population of hospital patients.

The ultrasound results in a population of (n = 45,319) hospital patients over a period of 10 years were examined retrospectively and evaluated for the diagnosis of benign focal liver lesions [hepatic cysts, hepatic hemangioma, focal nodular hyperplasia (FNH), hepatic adenoma, and focal fatty sparing]. Results that were incomplete or ambiguous were excluded from this study.

At least one of the lesions to be investigated was diagnosed in 15.1% (n = 6839) of the patients of the total population. The most commonly recorded lesion, with a total prevalence of 6.3% (n = 2839), was focal fatty sparing, followed by hepatic cysts with 5.8% (n = 2631). The prevalence of hepatic hemangioma was 3.3% (n = 1640), while that of FNH was 0.2% (n = 81) and that of hepatic adenoma was 0.04% (n = 19). An association between the occurrence of benign focal liver lesions and age was observed.

The calculated prevalence of benign focal liver lesions shows that on the fortuitous discovery of space-occupying lesions of the liver, first consideration should be given to focal fatty sparing, simple hepatic cysts and hemangiomas. The finding of a FNH or an adenoma is rarely a random discovery.

• Focal fatty sparing
• Focal liver lesions
• Focal nodular hyperplasia
• Hepatic adenoma
• Hepatic cysts
• Hepatic hemangioma