Hepatic Hemangioma Research Articles

Clinical features of cutaneous infantile hemangioma combined with asymptomatic infantile hepatic hemangioma and efficacy of propranolol treatment.

Infantile hepatic hemangioma (IHH) is a common liver tumor in infants and shares the same characteristics as cutaneous infantile hemangioma (IH). Propranolol is effective for symptomatic IHH. The clinical features between cutaneous IH and IHH, and treatment efficacy of IHH (smaller than 4 cm) is unclear. To evaluate the correlation of clinical features between cutaneous IH and IHH, as well as efficacy of systemic propranolol in the treatment of cutaneous IH combined with IHH. The clinical data of infants with complicated cutaneous IH combined with IHH treated with systemic propranolol (1.5 ~ 2 mg/(kg d)) from January 2011 to October 2020 were retrospectively analyzed. Forty-five cases with IHH combined with complicated cutaneous IH were reviewed. Single cutaneous IH is more likely to be combined with focal IHH, cutaneous IH greater than 5, more likely to be combined with multiple IHH (Pearson = 0.546, p < 0.01). The mean age of focal and multiple IHH regression was 11.93 ± 14.42 months and 10.20 ± 9.15 months, respectively. The number of cutaneous IH were correlated with the number of IHH. There was no difference in the age of complete remission for focal and multiple IHH.

Congenital hepatic hemangioma: an unusual case report of pulmonary hypertension

BackgroundPulmonary hypertension (PH) in newborns is a rare but serious condition that often requires immediate intervention and quick diagnosis of the correct etiology to prevent mortality. Congenital hepatic hemangioma (CHH) is an example of an extrathoracic etiology of PH.Case presentationHerein, we report the case of a newborn with a giant liver hemangioma, who presented with an early onset of PH and was successfully treated with intra-arterial embolization.ConclusionsThis case illustrates the importance of suspicion and prompt evaluation of CHH and related systemic arteriovenous shunts among infants with unexplained PH.

Pediatric hepatic vascular tumors: clinicopathologic characteristics of 33 cases and proposed updates to current classification schemes

Pediatric hepatic vascular tumors (HVTs) are rare neoplasms with features distinct from their cutaneous counterparts. Their behavior ranges from benign to malignant, with each subtype having therapeutic differences. Histopathologic descriptions of large cohorts are scarce in the literature. Thirty-three putative HVTs diagnosed from 1970 to 2021 were retrieved. All available clinical and pathologic materials were reviewed. Lesions were reclassified according to the World Health Organization (WHO) classification of pediatric tumors [1] ashepatic congenital hemangioma (HCH; n=13), hepatic infantile hemangioma (HIH; n=10), hepatic angiosarcoma (HA; n=3), and hepatic epithelioid hemangioendothelioma (HEH; n=1). Vascular malformations (n=5) or vascular-dominant mesenchymal hamartoma (n=1) were excluded. HCH frequently showed involutional changes, whereas HIH often had anastomosing channels and pseudopapillae formation. HA had solid areas with epithelioid and/or spindled endothelial morphology, significant atypia, increased mitoses, high proliferation index, and occasionally necrosis. On morphology analysis, a subset of HIH showed features worrisome for progression to HA including solid glomeruloidproliferation, increased mitoses, and epithelioid morphology. The widely metastatic and fatal HEH was observed in a 5-year-old male with multiple liver lesions. Immunohistochemically, HIHs and HA were Glucose transporter isoform 1 (GLUT-1) positive. One HIH patient died from postoperative complications, whereas 3 are alive without disease. Five HCH patients are alive and well. Two of three HA patients died of disease, and 1is alive without recurrence. To our knowledge, this is the largest series of pediatric HVTs reviewing clinicopathologic features based on current Pediatric WHO nomenclature [1]. We highlight diagnostic challenges and propose inclusion of an intermediate category between HIH and HA which warrants closer follow-up.

Evaluation of qualitative and quantitative imaging features of hepatic hemangiomas with and without pseudo-washout sign on gadoxetic acid-enhanced MRI: a descriptive and comparative study.

Hepatic hemangiomas are the most common benign liver tumors. It is important to know the imaging features of hemangiomas on gadoxetic acid (GA)-enhanced magnetic resonance imaging (MRI). To evaluate the qualitative and quantitative imaging features of hemangiomas on GA-enhanced MRI, and to compare imaging features of hemangiomas with and without pseudo-washout sign (PWS). We retrospectively included 93 cases of hemangioma that underwent GA-enhanced MRI. The presence of an enhancement pattern in the arterial phase (AP) and PWSs in the transitional phase (TP) were evaluated. Signal-to-norm ratios (SINorm) of hemangiomas, liver parenchyma, and portal vein (PV) as well as contrast-to-norm ratio (CNorm) were assessed. Additionally, hemangiomas with and without PWSs were defined as two separate subgroups, and imaging features were compared. Of the 93 cases of hemangiomas, 49 (52.6%) had PWSs in the TP. The mean SINorms of hemangiomas showed the highest value in the AP (P < 0.05). The mean CNorms showed positive values in the AP, and gradually decreased (P < 0.05). Hemangiomas with PWSs were significantly rapidly enhanced and smaller in size (P < 0.05), and the mean SINorms was lower in the TP (P = 0.023). While the mean CNorms showed a significant difference in the AP between subgroups (P < 0.001), the enhancement pattern was equal to that of the PV. When evaluating GA-enhanced MRI, radiologists should utilize quantitative measures in addition to qualitative assessment and should be aware that SI matching with PV in all phases can be a distinguishing finding in the diagnosis of hemangioma.

The Unexpected High Incidence of Hepatic Hemangiomas, With a Delayed-Phase Washout, During Contrast-Enhanced Ultrasound Utilizing a New Ultrasound Equipment System: A Case Series

The delayed imaging phase of hepatic hemangiomas, during a contrast-enhanced ultrasound (CEUS), was investigated utlizing a recent-generation ultrasound equipment system. From April 2021 to October 2021, ten patients (seven women and three men), with a median age of 52.2 years, were retrospectively reviewed, based on having a known or probable hepatic hemangioma, at least 15–60 mm in diameter. The CEUS examination was conducted using an Aplio i800 (Canon Medical Systems, Otawara, Japan) ultrasound equipment system and a blood pool contrast agent (SonoVue; Bracco, Milan, Italy). The imaging evaluation of the hemangiomas with CEUS was extended beyond 240 seconds from contrast injection. In this study, 80% of hepatic hemangiomas showed washout from 240 to 540 seconds, after contrast bolus injection. Previous studies indicated that hepatic hemangiomas demonstrated a washout in the delayed phase and were considered atypical and rare. However, by using a recent ultrasound equipment system, these lesions may appear more frequently. Since this atypical aspect of hemangioma could lead to confusion, based on a differential diagnosis, with liver malignancy, further studies are needed.

Risk factors analysis of surgical complications of hepatic hemangioma: a modified Clavien-Dindo classification-based study

PurposeThere are few studies on the risk factors of postoperative complications after surgical treatment of hepatic hemangioma (HH). This study aims to provide a more scientific reference for clinical treatment.MethodsThe clinical characteristics and operation data of HH patients undergoing surgical treatment in the First Affiliated Hospital of Air Force Medical University from January 2011 to December 2020 were retrospectively collected. All enrolled patients were divided into two groups based on the modified Clavien-Dindo classification: Major group (Grade II/III/IV/V) and Minor group (Grade I and no complications). Univariate and multivariate regression analysis was used to explore the risk factors for massive intraoperative blood loss (IBL) and postoperative Grade II and above complications.ResultsA total of 596 patients were enrolled, with a median age of 46.0 years (range, 22–75 years). Patients with Grade II/III/IV/V complications were included in the Major group (n = 119, 20%), and patients with Grade I and no complications were included in the Minor group (n = 477, 80%). The results of multivariate analysis of Grade II/III/IV/V complications showed that operative duration, IBL, and tumor size increased the risk of Grade II/III/IV/V complications. Conversely, serum creatinine (sCRE) decreased the risk. The results of multivariate analysis of IBL showed that tumor size, surgical method, and operative duration increased the risk of IBL.ConclusionsOperative duration, IBL, tumor size, and surgical method are independent risk factors that should be paid attention to in HH surgery. In addition, as an independent protective factor for HH surgery, sCRE should attract more attention from scholars.

99MTC RBC Scintigraphy in the Diagnosis of Hepatic Haemangioma

Abstract not available J Dhaka Med Coll. 2022; 31(1) : 167-169

Surgery for symptomatic hepatic hemangioma: Resection vs. enucleation, an experience over two decades.

Hemangiomas are the most common benign liver lesions; however, they are usually asymptomatic and seldom require surgery. Enucleation and resection are the most commonly performed surgical procedures for symptomatic lesions. This study aims to compare the outcomes of these two surgical techniques. A retrospective analysis of symptomatic hepatic hemangiomas (HH) operated upon between 2000 and 2021. Patients were categorized into the enucleation and resection groups. Demographic profile, intraoperative bleeding, and morbidity (Clavien-Dindo Grade) were compared. Independent t-test and chi-square tests were used for continuous and categorical variables respectively. p-value of < 0.05 was considered significant. Sixteen symptomatic HH patients aged 30 to 66 years underwent surgery (enucleation = 8, resection = 8) and majority were females (n = 10 [62.5%]). Fifteen patients presented with abdominal pain, and one patient had an interval increase in the size of the lesion from 9 to 12 cm. The size of hemangiomas varied from 6 to 23 cm. The median blood loss (enucleation: 350 vs. resection: 600 mL), operative time (enucleation: 5.8 vs. resection: 7.5 hours), and postoperative hospital stay (enucleation: 6.5 vs. resection: 11 days) were greater in the resection group (statistically insignificant). In the resection group, morbidity was significantly higher (62.6% vs. 12.5%, p = 0.05), including one mortality. All patients remained asymptomatic during the follow-up. Enucleation was simpler with less morbidity as compared to resection in our series. However, considering the small number of patients, further studies are needed with comparable groups to confirm the superiority of enucleation over resection.

Evaluation of Tc-99m Labeled Erythrocyte Scintigraphy with SPECT/CT in the Diagnosis of Hepatic Hemangioma

Amaç: Günümüzde görüntüleme yöntemlerindeki gelişmeyle birlikte karaciğer hemanjiomlarının saptanması da artmıştır. Genellikle asemptomatik olan karaciğer hemanjiomlarının, karaciğerin diğer primer ve metastatik malign tümörlerinden ayırıcı tanısının konulması gerekmektedir. Özellikle boyutu küçük olan ve ana vasküler yapılara yakın olan lezyonların tanısını koymak önemlidir. Bu tip lezyonlar Tc-99m işaretli eritrosit sintigrafisi ile doğru olarak tanımlanabilir. Bu çalışmanın amacı karaciğer hemanjiomlarının Tc-99m işaretli eritrosit sintigrafisinin SPECT/BT ile değerlendirilmesi ve tanıya olan katkısını araştırmaktır. Yöntem: Hemanjiom ön tanısı ile kliniğimize gönderilen 36 olgudaki 40 lezyon retrospektif olarak değerlendirildi. Modifiye in vivo yöntemle Tc-99m işaretli eritrosit sintigrafisi yapılan 36 hasta SPECT/BT ile görüntülendi. Hastalar 12-24 aylık klinik bulgu ve diğer görüntüleme yöntemleri (USG, BT ve MRG) ile takip edildi. Yapılan takiplerle lezyonların boyut ve morfolojisinde değişiklikler değerlendirilerek tanıları doğrulandı. Bulgular: SPECT/BT ile görüntülemede 36 olgunun 29’unda aktivite artışı saptandı ve bu olguların hepsi gerçek pozitif olarak değerlendirildi. 7 olguda aktivite tutulumu olmadı. 2 olgu kist hidatik, 4 olgu metastaz (1 kolon kanseri, 3 meme kanseri) olarak belirlendi. 1 olgu ise yanlış negatif olarak saptandı. Bu olguda lezyon boyutu 1 cm idi. Tc-99m işaretli eritrosit sintigrafisi-SPECT/BT ile sensitivite:%100; spesifite: %96,7; pozitif prediktif değer: %100; negatif prediktif değer: % 85,7 ve toplam tanı değeri: %97,3 olarak belirlendi. Ayrıca SPECT/BT’de 9 (%25) olguda lezyonlar ana vasküler yapılara yakın yerleşimli idi. Lezyonların 1’i kalbe, 3’ü vena kava inferiora, 5’i ise büyük hepatik damarlara yakın yerleşimli idi. BT sayesinde radyoaktivite akümülasyonunun olduğu odağın doğru anatomik lokalizasyonu yapılarak hastalara hemanjiom tanısı kondu. Sonuç: Tc-99m işaretli eritrosit sintigrafisi SPECT/BT sayesinde karaciğer hemanjiomlarının tespitinde sensitivitesi, spesifitesi ve doğruluğu yüksek olan, fonksiyonel ve anatomik görüntülemenin bir arada yapılmasına sağlayan noninvaziv bir görüntüleme yöntemidir.

Unusual presentation of a case of fetal hepatic mass: a case report

BackgroundGiant hepatic hemangiomas are rare and can cause serious complications that contribute to a high risk of perinatal mortality. The purpose of this article is to review the prenatal imaging features, treatment, pathology, and prognosis of an atypical fetal giant hepatic hemangioma and to discuss the differential diagnosis of fetal hepatic masses.Case presentationA gravida 9, para 0 woman at 32 gestational weeks came to our institution for prenatal ultrasound diagnosis. A complex, heterogeneous hepatic mass measuring 5.2 × 4.1 × 3.7 cm was discovered in the fetus using conventional two-dimensional ultrasound. The mass was solid and had both a high peak systolic velocity (PSV) of the feeding artery and intratumoral venous flow. Fetal magnetic resonance imaging (MRI) revealed a clear, hypointense T1-W and hyperintense T2-W solid hepatic mass. Prenatal diagnosis was very difficult due to the overlap of benign and malignant imaging features on prenatal ultrasound and MRI. Even postnatally, neither contrast-enhanced MRI nor contrast-enhanced computed tomography (CT) was useful in accurately diagnosing this hepatic mass. Due to persistently elevated Alpha-fetoprotein (AFP), a laparotomy was performed. Histopathological examination of the mass showed atypical features such as hepatic sinus dilation, hyperemia, and hepatic chordal hyperplasia. The patient was ultimately diagnosed with a giant hemangioma, and the prognosis was satisfactory.ConclusionsWhen a hepatic vascular mass is found in a third trimester fetus a hemangioma should be considered as a possible diagnosis. However, prenatal diagnosis of fetal hepatic hemangiomas can be challenging due to atypical histopathological findings. Imaging and histopathological assays can provide useful information for the diagnosis and treatment of fetal hepatic masses.

Coexisting Infantile Hepatic Hemangioma and Hepatoblastoma in a Neonate: A Case Report.

Infantile hepatic hemangioma and hepatoblastoma are the most common benign and malignant tumors of the liver in the neonatal and early childhood periods, respectively. However, the simultaneous occurrence of these 2 tumors in the same liver lesion is very rare. We report a case of a newborn infant diagnosed with a liver mass by ultrasound examination 4 days after birth. Serum alpha-fetoprotein (AFP) was elevated for his age (32,881.7 ng/mL). The liver mass was resected. Macroscopically, an externally protruding mass measuring 6 × 4 × 3.5 cm was identified. Microscopically, we observed the coexistence of infantile hepatic hemangioma and epithelial hepatoblastoma components within the tumor. The infantile hepatic hemangioma component was composed of multiple small vascular channels lined by endothelial cells. In the hepatoblastoma component, tumor cells were arranged in a 2- to 3-cell-thick trabecular formation. Immunohistochemistry indicated that the tumor cells in the infantile hepatic hemangioma component expressed CD34, CD31, FLI1, and ERG, and those in the hepatoblastoma component expressed hepatocyte, keratin AE1/AE3 and keratin 8, glypican 3, glutamine synthetase, and AFP. Pathological examination confirmed the presence of an infantile hepatic hemangioma combined with epithelial hepatoblastoma (fetal type). The boy did not undergo chemotherapy after the operation. Regular follow-up through serum AFP levels and liver ultrasound for 16 months to date show that the serum AFP levels decreased continuously to normal levels, with no signs of tumor recurrence or metastasis. The coexistence of infantile hepatic hemangioma and hepatoblastoma is rare. Hepatoblastoma should be considered in neonates with liver tumors and elevated AFP.

Clinical case of two-stage surgical treatment large liver hemangioma

Postresection hepatic insufficiency is a formidable complication after liver resections, leading to an unfavorable course of the postoperative period and, often, to a fatal outcome. The article presents a clinical case of successful surgical treatment of tumor of the liver and prophylactics of hard remnant liver insufficiency. The article presents the results of treatment of a patient with a large liver tumor by a staged method, a review of the immediate data is given retrospectively by describing the course of diagnosis and treatment of the disease. We have illustrated a case of successful two-stage surgical treatment of a patient with a large hemangioma of the liver using laparoscopic ligation of the right branch of the portal vein, which makes it possible to prevent the development of severe post-resection liver failure.

Thermal ablation of hepatic hemangioma: A multi-center experience with long-term outcomes

BackgroundThermal ablation, currently used extensively for liver tumors, also has been applied.successfully to hepatic hemangioma; however, it is still considered experimental because previous studies have comprised small sample sizes with short follow-up periods. PurposeWe aimed to investigate the effectiveness, safety, and long-term outcomes of thermal ablation for hepatic hemangioma. Materials and MethodsFrom October 2011 to February 2021, the data of 357 patients with 378 hepatic hemangiomas treated by thermal ablation at six hospitals were analyzed in this retrospective study. The technical success, safety, and long-term follow-up results were analyzed. ResultsA total of 252 patients (mean age, 49.2 ± 10.5 years) with 273 subcapsular hemangiomas underwent laparoscopic thermal ablation, whereas 105 patients with 105 hemangiomas located in the liver parenchyma underwent CT-guided percutaneous ablation. Of the 378 hepatic hemangiomas (5.0–21.2 cm), 369 lesions were subjected to one session of ablation, while 9 lesions were subjected to two sessions of ablation. Technical success was achieved in 100.0% of cases. Complete ablation was achieved in 361 of 378 hemangiomas (95.5%), while 17 hemangiomas (4.5%) were incompletely ablated, showing subtle enhancement at the peripheral rim. The major complication rate was 2.0% (7/357). The median follow-up period was 67 months (range, 12–124 months). Of the 224 patients with hemangioma-related symptoms, 216 demonstrated complete disappearance of symptoms (96.4%), while 8 were ameliorated (3.6%). Ablated lesion shrinkage was progressive, and 11.4% of hemangiomas almost completely disappeared over time (P < 0.01). ConclusionWith a reasonable ablation strategy and comprehensive treatment measurements, thermal ablation could be a safe, feasible, and effective treatment option for hepatic hemangioma.

Embolization of giant hepatic hemangioma: A case report

Introduction: Hepatic hemangiomas (HH) are the most common benign tumors of the liver and consist of vascular malformations or hamartomas of congenital origin that increase due to ectasia. The declared giant hepatic hemangiomas (GHH) embody from 10 cm (most commonly) to 20 or more cm

Surgical approach in liver hemangiomas with special emphasis on lesion diameter and type of surgery: a retrospective cohort of 69 patients

Purpose: Liver hemangioma (LH) being the most common benign tumor of the liver is a rare indication for liver surgery. Indications include symptomatic disease, diagnostic suspicion of malignancy, increase in lesion size, and Kasabach-Merritt syndrome. Surgical treatment mainly consists of enucleation or liver resection (LR). The study aimed to evaluate surgical outcomes in patients with LHs.&#x0D; Methods: In this study, surgical treatment for liver hemangioma in a single center were retrospectively reviewed. Demographics, preoperative and postoperative laboratory values, imaging studies, and follow-up data of patients were collected.&#x0D; Results: The mean age was 51.9±11.0 years and 69.6% were female. Abdominal pain was present preoperatively in 32 (46.4%) cases. Mean lesion diameter was 7.5 (1.2-20) cm. Giant hemangioma was reported in 54 (78.3%) patients. Liver resection (LR) and enucleation were preferred for 37 (53.6%) and 32 (46.4%) patients, respectively. Intraoperative transfusion requirement was more common in enucleation than LRs (78.1% vs. 48.6%, p=0.012). Intraoperative erythrocyte transfusion was more frequently in operations of giant hemangiomas (68.5% vs. 40.0%, p=0.044). Complications were observed more frequently in giant hemangioma group regardless of grades (40.7% vs. 13.3%, p=0.049). Preoperative thrombocytopenia was found more frequent in cases with serious complications (66.7% vs 22.2%, p=0.019).&#x0D; Conclusion: Emerging percutaneous intervention and imaging modalities are expected to decrease number of surgeries for liver hemangiomas. Although enucleation, LR and even liver transplantation are still required for a set of patients. Enucleation and LR have similar outcomes, but transfusions are more common according to the present study. Size of LHs is related with complications and transfusion requirements.

A systematic review and meta-analysis of spectral CT to differentiate focal liver lesions

To determine the feasibility of spectral computed tomography (CT) in the differentiation of focal liver lesions from hepatocellular carcinoma (HCC) using a network meta-analysis (NMA). The review was completed in accordance with PRISMA guidelines. Searches of three medical databases were performed. A total of nine articles were found for the qualitative synthesis. The meta-analysis was performed on five studies for the normalised iodine concentration (NIC; which is the iodine concentration in the lesion divided by the iodine concentration in the aorta) and the lesion-normal parenchyma iodine ratio (LNR; which is the iodine concentration in the lesion divided by the iodine concentration in the non-tumour hepatic parenchyma) on portal venous and arterial phase images due to sufficient data. Spectral CT can be used to differentiate HCC from hepatic haemangioma (HH), focal nodular hyperplasia (FNH), regenerative nodules, neuroendocrine tumours (NETs), abscesses, and angiomyolipoma (AML). Hepatic metastases versus abscess and FNH versus HH could also be differentiated. The NMA demonstrated that HCC, NETs, and regenerative nodules could be differentiated due to lower quantitative iodine values. FNH, AML, and HH all had higher values. Spectral CT shows promise in differentiating focal liver lesions. Studies with larger sample sizes are warranted. Future studies should be performed comparing benign lesions using quantitative markers.

Can angiogenesis inhibitor therapy cause changes in imaging features of hepatic hemangioma- Initial study.

To observe whether anti-angiogenesis therapy can induce changes in size and enhancement characteristics of hepatic hemangioma. 133 patients with hepatic hemangioma lesions were analyzed and classified into a Bevacizumab group (n=65) and the control group (n=68). The parameters (Volume, CT enhancement ratio, enhancement patterns) of pre-and post-treatment in the bevacizumab and control groups independently calculated and compared by two radiologists. Correlation among the systolic blood pressure, diastolic blood pressure, heart rate with the hemangioma volume was evaluated using Pearson's correlation analysis. The hepatic hemangioma volume was significantly decreased after treatment in the Bevacizumab group (8.6 ± 18.7mL vs.7.3 ± 16.3mL, P<0.05), and there was no significant change in the control group (15.1 ± 19.8mL vs.15.4 ± 20.7mL, P = 0.504). A significant difference in enhancement patterns of hepatic hemangiomas was observed after treatment with Bevacizumab (P<0.01). There was no significant difference in arterial phase (AP)enhancement rate and arterial phase-portal venous phase (AP-PVP) enhancement ratios after treatment in the Bevacizumab and control groups (Ps>0.05).The Pearson correlation results showed that blood pressure, heart rate, and hemangioma volume were unrelated or weakly related before and after bevacizumab treatment under the control of factors including weight, contrast injection scheme and CT scanning scheme. Anti-angiogenesis therapy can cause changes in enhancement pattern and volume of hepatic hemangioma. Radiologists should pay more attention to the reexamination of tumor patients treated with anti-angiogenesis therapy.

Laparoscopic Hepatectomy for Giant Hepatic Hemangioma Using the Involved Intrahepatic Anatomic Markers Approach

BackgroundHepatic hemangioma has been one of the absolute indications of laparoscopic hepatectomy (LH).1 However, the risk of catastrophic intraoperative bleeding and the difficulty to control it make the laparoscopic treatment of giant hepatic hemangioma (GHH) a technical challenge for hepatobiliary surgeons.2 Herein, we presented a video of LH for GHH using the involved intrahepatic anatomic markers approach. MethodsA 22-year-old female was referred for treatment of an intractable GHH (18 cm), which involved the left hepatic pedicle, left hepatic vein (LHV), and middle hepatic vein (MHV), resulting in the invisibility of the above intrahepatic anatomic markers on CT. The procedure was performed according to the following steps: (1) dissecting and ligating the left hepatic artery (LHA) and left portal vein (LPV) via intrafascial approach, respectively; (2) cutting the accessory LHA; (3) transecting parenchymal along the demarcation line in a caudal-to-cranial direction and exposing the involved caudal middle hepatic vein (MHV); (4) isolating and transecting the involved left hepatic duct; (5) preserving the integrity of involved MHV; (6) isolating and transecting the left hepatic vein (LHV) and splenic vein (SV); (7) mincing and extracting the specimen. This study was approved by the West China Hospital Ethics Committee and was conducted in accordance with the ethical guidelines of the Declaration of Helsinki. All treatments were performed after obtaining written informed consent from the patients. ResultsThe operative time was 286 min, and blood loss during operation was 160 ml. This procedure ensured the integrity of MHV and maximized the residual functional hepatic volume. The histopathologic examination confirmed the hepatic cavernous hemangioma. The patient had an uneventful postoperative recovery and was discharged on the fifth day after operation. ConclusionLH using the involved intrahepatic anatomic markers approach is feasible and effective for intractable GHH. Its advantages lie in decreasing the risk of disastrous hemorrhage or open conversion rate while maximizing the postoperative functional hepatic reserve.3

Characterization of Incidental Liver Lesions: Comparison of Multidetector CT versus Ultrasonography

Background: Due to recent advancements in imaging techniques, as well as the widespread use of routine medical exams and screenings, incidental LL are now more frequently discovered by US. Physicians must decide whether to simply follow up when incidental LL are discovered in the US or to order additional imaging tests for lesion classification. The goal of our study was to identify LL using MDCT and US. Methods and Results: A total of 50 participants were selected from a variety of male and female patients with abdominal pain and suspected liver diseases, and received a CT triphasic scan and US at the Royal Care International Hospital, Ibn Alhaitham Diagnostic Center, Alfaisal Specialized Hospital, and the Department of Diagnostic Radiology in the CT department of Sudan from April 2018 to May 2020. The results of the ultrasound scanning (liver lesions and related findings) performed on patients before the CT scanning indicated that ascites+ liver lesions was predominant (48.6%). The incidental liver lesions that take peripheral nodular enhancement by MDCT when contrast media is injected, were liver metastases (30%), hemangioma (14%), and HCC (10%). Liver cysts represent 10(20%) of the total cases of lesions that were non-enhanced by CT, with a few cases of liver cirrhosis (2%), hepatosplenomegaly (2%), and cyst + hepatitis (2%). We found a significant relationship between peripheral nodular enhancement for liver lesions by MDCT and non-enhancing liver lesions (P=0.001). Conclusion: The US and CT scan findings have a statistically significant relationship (P≤0.017). Contrast-enhanced CT performs better at diagnosing liver lesions than does standard US.

Bleomycin-Ethiodized Oil Transarterial Embolization of a Giant Hepatic Hemangioma

Bleomycin-Ethiodized Oil Transarterial Embolization of a Giant Hepatic Hemangioma