Diagnosis and management of massive hepatic hemangiomas in childhood

Twelve patients diagnosed as having hepatic hemangiomas during 1960 to 1982 at the Royal Children's Hospital, Melbourne are reviewed. This rare benign vascular tumor can present considerable problems in both diagnosis and management and has a high reported mortality. Our experience over this 23-year period demonstrates some of the difficulties in diagnosis and suggests a plan of management. Eight patients were diagnosed when five weeks of age or less, the youngest was 24 hours old. One was diagnosed at four months of age. In the remaining three patients, the diagnosis was made at postmortem. Ten patients had prominent hepatomegaly, nine had congestive cardiac failure and in one of these the onset was delayed four weeks. Thrombocytopenia was present in five and jaundice in four patients. Four patients had associated cutaneous or visceral hemangiomas. Seven patients underwent selective hepatic arteriography, and two of these had prior ultrasound examinations of the liver. Management of congestive cardiac failure included steroids, radiotherapy, hepatic resection, and in one patient, hepatic artery ligation. One patient with diffuse hepatic hemangiomas did not require any specific therapy and resolved spontaneously over two years. The four patients in whom hepatic resection was performed survived.