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What Causes Hemangioma Of Liver?

Posted on Sat, 3 May 2014

Question: You asked: I did last year an ultrasound & it showed a fatty liver . & this month i did another one but this time it showed Small right hepatic lobe benign mass lesion likely hemangioma . Then my doctor told me to do Tri phasec CT scan which showed : There is right hepatic lobe segment 8 peripheral subcapsular focal lesion at arterial and porto venous proses . It appear isodense to the liver at delayed phase it is 1.5 cm diameter.the possibility hemangioma associated for close follow up . My question is why i didn't found it in the previous ultrasound of the last year ? Why he wrote possibility of hemangioma ? N.B i did alpha feto protein test & it was 1.8 . Thanks God

Answered by Dr. Vivek Chail (1 hour later)

Brief Answer: Please find detailed answer below Detailed Answer: Hi XXXXX, Thanks for writing in to us. I have read through your query in detail. There are many reasons as to why it was not picked up on ultrasound last year. It might have been very small in size. The location of the hemangioma is described as subcapsular and therefore can be missed due to technical and operator factors. The size of 1.5 cm is not too big and can be easily missed due to any gas in the bowel. Its mentioned possibility of hemangioma because on delayed phase the lesion has density uniform to that of the surrounding liver. This means it is showing delayed uptake and can be considered as a typical hemangioma. Hemangiomas are harmless benign lesions commonly seen in many people. You may need to repeat your ultrasound 6 monthly or yearly to make sure it isnt growing fast. Alpha feto protein AFP is measured in nanograms per milliliter (ng/mL). An AFP level of less than 10 ng/mL is normal for adults. An extremely high level of AFP in your blood – greater than 500 ng/mL – could be a sign of liver tumors. Hope your query is answered. Do write back if you have any doubts. Regards, Dr.Vivek

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Vivek Chail (4 hours later)

Thanks Dr XXXXXXX for your quick response . So what i want to make sure is that the Radiologist can easily diffrentiate between cancer & Hemangiomas ? Even if the hemangioma is too small ? Is this hemangioma a birthmark or it can happen at any age ? I mean is it a new thing on my liver or it is from my date of birth ? Thank s

Answered by Dr. Vivek Chail (2 hours later)

Brief Answer: Please find detailed answer below Detailed Answer: Hi XXXXX, Thanks for writing in with an update. In my experience a 1.5 cm lesion showing imaging characteristics described in your report almost always refers to a hemangioma which is an abnormal entanglement of blood vessels in the liver (much like any other birth mark over the skin). It is present from birth in most patients and in some people it can grow in size with time. In most patients it goes undetected and is usually found during routine investigation as in you. I would recommend an ultrasound every 6 months or yearly for few years to make sure it is not any thing else. Hope your query is answered. Do write back if you have any doubts. Regards, Dr.Vivek

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Vivek Chail (45 minutes later)

Is there any mean that can detect & confirm if it is hemangioma or something else as i don't want to live in fear for 6 months or a years i am very concerned about my health . & what i need to know too do the tri phasec CT scan couldn't confirm the type of the mass lesion .

Answered by Dr. Vivek Chail (4 hours later)

Brief Answer: Please find detailed answer below Detailed Answer: Hi XXXXX, Thanks for writing in with an update. Most liver hemangiomas are small and asymptomatic at the time of diagnosis, and they are likely to remain that way. In one prospective study, an increase in hemangioma size was noted in only one of 47 patients who were rescanned 1-6 years after the initial diagnosis. There is no malignant transformation seen in hemangiomas and most liver hemangiomas may be left safely alone. The modalities used to aid in the diagnosis of liver hemangiomas include ultrasonography, triphasic contrast-enhanced computed tomography (CT) scanning, nuclear medicine studies using technetium-99m (99m Tc) – labeled RBCs, magnetic resonance imaging (MRI), hepatic arteriography, and digital subtraction angiography. Normal alpha-fetoprotein, CA 19-9, and carcinogenic embryonic antigen (CEA) levels bolster clinical suspicion of a benign liver mass lesion. Research shows that sensitivities of imaging investigations as follows: Ultrasonography – 46% sensitivity Combined B-mode and color Doppler ultrasonography – 69% sensitivity Contrast-enhanced CT scanning - 66% sensitivity T2-weighted MRI - 96% sensitivity Gadolinium-enhanced MRI combined with dynamic CT scanning - 100% sensitivity Further hemangiomas smaller than 2 cms are difficult to confirm by any single imaging modality. MRI and 99mTc-RBC SPECT are the most accurate radiologic studies to establish the diagnosis of a small hepatic hemangioma. In your situation MRI is an investigation of choice to confirm liver hemangioma. Hope your query is answered. Do write back if you have any doubts. Regards, Dr.Vivek

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Vivek Chail (2 hours later)

Do you think i need to do the MRI or am i maximizing the problem & i don't need all of this. If i was your patient what you will advise me ? Thanks

Answered by Dr. Vivek Chail (7 hours later)

Brief Answer: Please find detailed answer below Detailed Answer: Hi XXXXX, Thanks for writing back with an update. I feel that you do not absolutely need a MRI. For my patients I would double confirm the hemangioma on ultrasound and Doppler and tell the patient to see me again in 3 months for another ultrasound. At the same time I would also take any detailed history of clinical problems should there be anything else to discuss. Regards, Dr.Vivek

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar