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Abstract
Hepatic hemangiomas are typically asymptomatic benign liver tumors. This report describes a case of a large hepatic hemangioma with internal bleeding and necrosis, presenting as fever of unknown origin, which was successfully treated with surgical resection. A woman in her 40s presented with persistent fever and fatigue. Imaging revealed a 13 cm mass in the posterior sector of the right hepatic lobe, with areas of high attenuation suggestive of internal bleeding. Laboratory tests revealed elevated levels of C-reactive protein, interleukin-6, and complement components (C3, C4, and CH50), along with an increased erythrocyte sedimentation rate. Symptomatic treatment with antipyretic medications failed to resolve the fever; therefore, hepatic resection was performed for diagnostic and therapeutic purposes. Post-operative recovery was uneventful, and the fever resolved completely. Pathological examination revealed cavernous hemangioma with well-defined necrotic areas. Post-operative blood tests showed normalization of the preoperatively elevated prognostic markers. Bleeding and necrosis associated with a large hemangioma appear to trigger the release of damage-associated molecular patterns, stimulating interleukin 6 production, promoting prostaglandin E2 synthesis, and ultimately leading to fever. Hepatic resection is an effective treatment for large hemangiomas in patients presenting with fever.
Highlights
Hepatic hemangiomas are common benign liver tumors, accounting for 73% of all benign hepatic tumors [1]
The giant hepatic hemangioma in this case resulted in internal necrosis and fever of unknown etiology
The presence of neutrophils, monocytes, and fibrin deposition in the border zone suggests that extensive infarction occurred within the hepatic hemangioma and that an inflammatory reaction may have occurred at the infarct margin
Summary
Hepatic hemangiomas are common benign liver tumors, accounting for 73% of all benign hepatic tumors [1]. Hemangiomas consist of blood-filled cavities lined with endothelial cells and are supplied by branches of the hepatic artery [4]. Their development may be influenced by congenital anomalies,. Laboratory findings revealed the following: white blood cell count, 6,800/μL (); C-reactive protein (CRP), 10.36 mg/dL (elevated); aspartate aminotransferase, 53 U/L; alanine aminotransferase, 63 U/L; alkaline phosphatase, 295 U/L (mildly elevated); hemoglobin, 8.9 g/ dL (mild anemia); coagulation parameters, normal; elevated. Abdominal contrast-enhanced CT revealed a 13 cm giant mass in the posterior segment of the right hepatic lobe, with hyperdense areas suggestive of hemorrhage (Fig. 2). Complement levels (C3, C4, and CH50) and ESR returned to normal
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