Abstract
Multifocal hepatic hemangioma (MHH) is a benign hepatic tumor that is commonly diagnosed in children with multiple cutaneous infantile hemangiomas (IHs). We present a review of all children with MHH at our institutions. Of the 42 patients, the median age at presentation of MHH was 2.5 months. Thirty-six (85.7%) patients had cutaneous IHs. Twelve (28.6%) patients were symptomatic at presentation. There was no significant association between the number of hepatic hemangiomas and the number of cutaneous IHs. Fourteen (33.3%) patients received some form of treatment for hepatic hemangiomas. The most common type of treatment was oral prednisone in 8 patients, followed by oral propranolol in 6 patients. Two patients were totally resistant to prednisone treatment. They died from congestive heart failure or respiratory distress and coagulopathy. Two patients with problematic facial IH were treated with intralesional triamcinolone injection. The remaining 26 patients were managed with imaging surveillance. On follow-up, all of the survivors had a favorable outcome. Our study suggests that the clinical features of MHH are variable. Our data emphasize the treatment strategy that aggressive treatment is indicated in symptomatic or progressive MHHs, whereas observation management of asymptomatic patients with a few small lesions is safe and appropriate.
Highlights
Multifocal hepatic hemangioma (MHH) is a benign hepatic tumor that is commonly diagnosed in children with multiple cutaneous infantile hemangiomas (IHs)
Multifocal hepatic hemangiomas (HHs) (MHHs) are individual lesions separated by normal intervening liver parenchyma whereas diffuse HHs are characterized by extensive replacement of the hepatic parenchyma with innumerable lesions[1,4,5]
MHHs are detected more often by abdominal ultrasound (US) in patients associated with multiple cutaneous Infantile hemangiomas (IHs)
Summary
Multifocal hepatic hemangioma (MHH) is a benign hepatic tumor that is commonly diagnosed in children with multiple cutaneous infantile hemangiomas (IHs). There was no significant association between the number of hepatic hemangiomas and the number of cutaneous IHs. Fourteen (33.3%) patients received some form of treatment for hepatic hemangiomas. Infantile hepatic hemangiomas (HHs) represent the most common hepatic tumors in children. Focal HHs are the hepatic form of cutaneous rapidly involuting congenital hemangiomas and are histologically distinct from IHs1. Multifocal and diffuse HHs are true IHs, undergoing parallel phases of growth and involution to cutaneous lesions[2]. MHHs are detected more often by abdominal ultrasound (US) in patients associated with multiple cutaneous IHs. histologically benign, MHHs have a varied presentation. Children with diffuse lesions are more likely to have a serious clinical course, with a greater risk of morbidity and mortality
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