Hepatic haemangioma

Hepatic haemangioma

Description

Small haemangiomata are sometimes found incidentally at the time of necropsy and probably are of little significance. In the fetus very large hepatic haemangiomata can be rarely seen. These are benign tumours which will usually resolve following delivery. However their size and their large vascular interconnections may provoke heart failure in the fetus with the development of hydrops. Under these circumstances a fatal outcome becomes a possibility.

Diagnosis

These tumours will usually be detected incidentally whilst a scan is being undertaken for other reasons. However sometimes the mother will present with polyhydramnios as a secondary feature of hydrops. The appearances of the liver will suggest the diagnosis and invasive investigations such as biopsy do not seem justifiable.

Differential Diagnosis

Cystic spaces in the liver may arise as part of the infantile polycystic kidney sequence although this is rarely seen in the fetus. The absence of blood flow through the cysts should aid diagnosis. Hepatic cyst will not be associated with blood flow.

Sonographic Features

Large lacunae within the substance of the liver

Evidence of blood flow within the lacunae using colour flow Doppler

Enlarged fetal girth at the level of the liver

Evidence of hydrops may exist

Associated Syndromes

  • Blue rubber bleb nevus
  • Klippel-Trenaunay-Weber
  • Maffucci
  • Proteus
  • Von Hippel-Lindau

References

  1. Nakamoto SK, Dreilinger A, Dattel B, Mattrey RF, Key TC The sonographic appearance of hepatic haemangioma in utero J Ultrasound Med 2:239-241
  2. Sepulveda WH, Donetch G, Giuliano A Prenatal diagnosis of fetal hepatic haemangioma Eur J Obstet Gynecol Reprod Biol 48:73-76