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Hepatic Hemangiomas, Infantile and Congenital
A. Carlson Merrow, Jr., MD, FAAP
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KEY FACTS

  • Terminology

    • Imaging

      • Clinical Issues

        TERMINOLOGY

        • Synonyms

          • Not hemangioendothelioma (more aggressive vascular tumor not typically found in infantile liver)
          • Not cavernous hemangioma (venous malformation not typically found in infantile liver)
        • Definitions

          • Hemangioma: Benign endothelial neoplasm occurring in soft tissues or viscera (especially liver: Most common benign hepatic tumor of infants)
            • 70% of 2009 publications used term hemangioma incorrectly
          • Congenital hemangioma (CH): Found in perinatal period, does not proliferate beyond birth
            • Rapidly involuting (RICH) vs. noninvoluting (NICH) subtypes
              • RICH almost entirely involuted by 14 months of age
              • RICH >> NICH in liver
          • Infantile hemangioma (IH)
            • Not present at birth
            • Proliferating phase: Lesion(s) develop during 1st few weeks of life with rapid growth over next few months
            • Involuting phase: Slow regression of lesion(s) over years, usually beginning by 12 months of age

        IMAGING

        • General Features

          • Radiographic Findings

            • CT Findings

              • MR Findings

                • Ultrasonographic Findings

                  • Imaging Recommendations

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        • Microscopic Features

                          CLINICAL ISSUES

                          • Presentation

                            • Demographics

                              • Natural History & Prognosis

                                • Treatment

                                  DIAGNOSTIC CHECKLIST

                                  • Consider

                                    • Image Interpretation Pearls

                                      Selected References

                                      1. Rialon KL et al: Risk factors for mortality in patients with multifocal and diffuse hepatic hemangiomas. J Pediatr Surg. 50(5):837-41, 2015
                                      2. Rialon KL et al: Impact of screening for hepatic hemangiomas in patients with multiple cutaneous infantile hemangiomas. Pediatr Dermatol. 32(6): 808-12, 2015
                                      3. Wassef M et al: Vascular anomalies classification: recommendations from the international society for the study of vascular anomalies. Pediatrics. 136(1):e203-14, 2015
                                      4. Hsi Dickie B et al: Hepatic vascular tumors. Semin Pediatr Surg. 23(4):168-72, 2014
                                      5. Liang MG et al: Infantile and congenital hemangiomas. Semin Pediatr Surg. 23(4):162-7, 2014
                                      6. Kulungowski AM et al: Lessons from a liver hemangioma registry: subtype classification. J Pediatr Surg. 47(1):165-70, 2012
                                      7. Roebuck D et al: Rapidly involuting congenital haemangioma (RICH) of the liver. Pediatr Radiol. 42(3):308-14, 2012
                                      8. Chung EM et al: From the archives of the AFIP: Pediatric liver masses: radiologic-pathologic correlation. Part 2. Malignant tumors. Radiographics. 31(2):483-507, 2011
                                      9. Restrepo R et al: Hemangiomas revisited: the useful, the unusual and the new. Part 1: overview and clinical and imaging characteristics. Pediatr Radiol. 41(7):895-904, 2011
                                      10. Restrepo R et al: Hemangiomas revisited: the useful, the unusual and the new. Part 2: endangering hemangiomas and treatment. Pediatr Radiol. 41(7):905-15, 2011
                                      11. Chung EM et al: From the archives of the AFIP: pediatric liver masses: radiologic-pathologic correlation part 1. Benign tumors. Radiographics. 30(3):801-26, 2010
                                      12. Christison-Lagay ER et al: Hepatic hemangiomas: subtype classification and development of a clinical practice algorithm and registry. J Pediatr Surg. 42(1):62-7; discussion 67-8, 2007
                                      Related Anatomy
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                                      Related Differential Diagnoses
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                                      References
                                      Tables

                                      Tables

                                      KEY FACTS

                                      • Terminology

                                        • Imaging

                                          • Clinical Issues

                                            TERMINOLOGY

                                            • Synonyms

                                              • Not hemangioendothelioma (more aggressive vascular tumor not typically found in infantile liver)
                                              • Not cavernous hemangioma (venous malformation not typically found in infantile liver)
                                            • Definitions

                                              • Hemangioma: Benign endothelial neoplasm occurring in soft tissues or viscera (especially liver: Most common benign hepatic tumor of infants)
                                                • 70% of 2009 publications used term hemangioma incorrectly
                                              • Congenital hemangioma (CH): Found in perinatal period, does not proliferate beyond birth
                                                • Rapidly involuting (RICH) vs. noninvoluting (NICH) subtypes
                                                  • RICH almost entirely involuted by 14 months of age
                                                  • RICH >> NICH in liver
                                              • Infantile hemangioma (IH)
                                                • Not present at birth
                                                • Proliferating phase: Lesion(s) develop during 1st few weeks of life with rapid growth over next few months
                                                • Involuting phase: Slow regression of lesion(s) over years, usually beginning by 12 months of age

                                            IMAGING

                                            • General Features

                                              • Radiographic Findings

                                                • CT Findings

                                                  • MR Findings

                                                    • Ultrasonographic Findings

                                                      • Imaging Recommendations

                                                        DIFFERENTIAL DIAGNOSIS

                                                          PATHOLOGY

                                                          • General Features

                                                            • Microscopic Features

                                                              CLINICAL ISSUES

                                                              • Presentation

                                                                • Demographics

                                                                  • Natural History & Prognosis

                                                                    • Treatment

                                                                      DIAGNOSTIC CHECKLIST

                                                                      • Consider

                                                                        • Image Interpretation Pearls

                                                                          Selected References

                                                                          1. Rialon KL et al: Risk factors for mortality in patients with multifocal and diffuse hepatic hemangiomas. J Pediatr Surg. 50(5):837-41, 2015
                                                                          2. Rialon KL et al: Impact of screening for hepatic hemangiomas in patients with multiple cutaneous infantile hemangiomas. Pediatr Dermatol. 32(6): 808-12, 2015
                                                                          3. Wassef M et al: Vascular anomalies classification: recommendations from the international society for the study of vascular anomalies. Pediatrics. 136(1):e203-14, 2015
                                                                          4. Hsi Dickie B et al: Hepatic vascular tumors. Semin Pediatr Surg. 23(4):168-72, 2014
                                                                          5. Liang MG et al: Infantile and congenital hemangiomas. Semin Pediatr Surg. 23(4):162-7, 2014
                                                                          6. Kulungowski AM et al: Lessons from a liver hemangioma registry: subtype classification. J Pediatr Surg. 47(1):165-70, 2012
                                                                          7. Roebuck D et al: Rapidly involuting congenital haemangioma (RICH) of the liver. Pediatr Radiol. 42(3):308-14, 2012
                                                                          8. Chung EM et al: From the archives of the AFIP: Pediatric liver masses: radiologic-pathologic correlation. Part 2. Malignant tumors. Radiographics. 31(2):483-507, 2011
                                                                          9. Restrepo R et al: Hemangiomas revisited: the useful, the unusual and the new. Part 1: overview and clinical and imaging characteristics. Pediatr Radiol. 41(7):895-904, 2011
                                                                          10. Restrepo R et al: Hemangiomas revisited: the useful, the unusual and the new. Part 2: endangering hemangiomas and treatment. Pediatr Radiol. 41(7):905-15, 2011
                                                                          11. Chung EM et al: From the archives of the AFIP: pediatric liver masses: radiologic-pathologic correlation part 1. Benign tumors. Radiographics. 30(3):801-26, 2010
                                                                          12. Christison-Lagay ER et al: Hepatic hemangiomas: subtype classification and development of a clinical practice algorithm and registry. J Pediatr Surg. 42(1):62-7; discussion 67-8, 2007