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Efficacy of infantile hepatic hemangioma with propranolol treatment: A case report
Mu-Chieh Tsai1, Hsi-Che Liu2,3, Chun-Yan Yeung1,3,4
1Division of Gastroenterology and Hepatology, Department of Pediatrics, MacKay Children's Hospital.
Insights
Early diagnosis and propranolol treatment are crucial for infantile hepatic hemangiomas. This case study shows successful resolution of multiple hepatic hemangiomas in an infant using propranolol therapy.
Area of Science:
- Pediatric Hepatology
- Medical Imaging
- Pharmacology
Background:
- Infantile hepatic hemangiomas are rare vascular liver tumors.
- While often asymptomatic, they can lead to severe complications.
- Early detection is critical for effective management.
Observation:
- A 2-month-old infant presented with incidentally discovered multiple hepatic lesions.
- Initial physical examination and vital signs were normal.
- Diagnosis of infantile multiple hepatic hemangiomas was confirmed via ultrasound and CT scan.
Findings:
- Treatment with propranolol, initiated at 3 months of age, showed rapid improvement.
- Hepatic lesions significantly decreased in size within 10 days.
- Complete resolution of hemangiomas was achieved after 4.5 months of therapy.
- No recurrence was observed during an 11-month follow-up period.
Implications:
- This case supports propranolol as a first-line treatment for infantile hepatic hemangiomas.
- Prompt diagnosis and intervention can prevent severe outcomes.
- Further research into optimal propranolol dosing protocols is warranted.
Rationale:
Hepatic hemangioma is rarely discovered during the infantile period. Although most of the cases are asymptomatic, some of them may suffer life-threatening situations. In this regard, early detection is mandatory for preventing the ominous consequences that might be culminated from the disease.
Patient Concerns:
A 2-month-14-day-old female infant was found incidentally to have multiple hepatic lesions during a newborn ultrasound screen. She was born smoothly at term after a non-eventful pregnancy course. Physical examination was completely normal and postnatal vital signs were stable.
Diagnosis:
Infantile multiple hepatic hemangiomas.
Intervention:
High-resolution ultrasound and abdominal computer tomogram were conducted to confirm the diagnosis. Propranolol was started at the age of 3 months and 7 days old with an initial dosage of 1.5 mg/kg per day and increased gradually to 2.5 mg/kg per day. No obvious adverse effects were noted during the treatment course. Rapid clinical improvement with decreasing size was observed by ultrasound 10 days after the treatment. Eventually, hepatic lesions totally disappeared 4.5 months later. Propranolol in dosage of 2.5 mg/kg per day was continued until 6 months after the initial prescription.
Outcomes:
A period of 11-month follow-up revealed no evidence of recurrence of hemangiomas.
Lessons:
Early diagnosis and intervention are mandatory for infantile hepatic hemangiomas to prevent possible ominous consequences. Though the propranolol therapy protocol for the disease is still under developing, the current report strengthens the recommendation to use propranolol as the first-line medication for treating infantile hepatic hemangiomas.
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