A Giant Hepatic Hemangioma Presenting With Bilateral Pulmonary Embolism: A Case Report

Hepatic hemangiomas are the most common benign tumors found in the liver. Herein, we present a case of a giant hepatic hemangioma (>4 cm) complicated by bilateral pulmonary embolism originating from the inferior vena cava thrombus with clinical and radiological features of portal hypertension. A 52-year-old woman presented to the emergency department of our institution with a history of blackouts. She underwent an extensive workup for potential causes of syncope, and a massive bilateral pulmonary embolism was detected. On examination, the patient was conscious, and her vital signs were within normal ranges. Abdominal examination revealed massive ascites and irregular nodular hepatomegaly without splenomegaly. Laboratory test results revealed normal liver function. The patient had elevated D-dimer levels. The serum-ascites albumin gradient was not elevated. Tumor marker levels were all within the normal range, and autoimmune profile results and test results for thrombophilia markers were negative. Abdominopelvic CT demonstrated hepatomegaly and a giant fungating chronic hepatic hemangioma occupying the right lobe along with an infrarenal inferior vena cava thrombus. The patient was discharged and prescribed a therapeutic dose of enoxaparin and diuretics. As the patient was not a candidate for resection due to the large hemangioma size and invasion of the liver tissue, she was referred to another center for a liver transplant. Hepatic hemangiomas are benign lesions and are usually managed conservatively since surgical intervention is controversial and is reserved for symptomatic or complicated cases. With an anatomically challenging lesion, enucleation/resection could not be achieved, and liver transplantation was the best achievable option.