"No Touch to Touch": Percutaneous Sclerotherapy of a Giant Hepatic Cavernous Hemangioma

Cavernous hemangiomas were originally taught as "no touch lesions" as they were benign, hypervascular, venous malformations. They are commonly found in the liver. Patients typically present asymptomatically, and these hemangiomas can be found incidentally on imaging as solitary or multiple lesions. A 42-year-old male patient arrived at our institution after a motor vehicle collision, and a giant hemangioma was found incidentally on imaging with a classic feature of peripheral nodular enhancement on arterial phase computed tomography (CT) imaging. However, the patient continued to report right upper quadrant pain. Given the patient's age and size of the lesion, percutaneous sclerotherapy using bleomycin and lipiodol was performed. At the two-week follow-up, the patient denied fever, nausea, vomiting, or pain. At six months, the patient was asymptomatic, and follow-up CT angiography (CTA) demonstrated an approximately 50% reduction in lesion size. Therefore, percutaneous sclerotherapy is an effective, low-risk, and technically straightforward treatment alternative to the traditional intraarterial approach, resulting in significant lesion size reduction and meaningful symptomatic relief with a favorable safety profile.