What are the clinical features of hepatic hemangiomas?

Updated: Jun 17, 2019
  • Author: David C Wolf, MD, FACP, FACG, AGAF, FAASLD; Chief Editor: BS Anand, MD  more...
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Hepatic hemangiomas are more common in the right lobe of the liver than in the left lobe.

Hemangiomas of the liver are usually small and asymptomatic. They are most often discovered when the liver is imaged for another reason or when the liver is examined at laparotomy or autopsy. [9] Larger and multiple lesions may produce symptoms that necessitate surgery. Goodman noted that symptoms are experienced by 40% of patients with 4-cm hemangiomas and by 90% of patients with 10-cm hemangiomas. [18]

Right upper quadrant pain or fullness is the most common complaint. [9] In some cases, pain is explained by thrombosis and infarction of the lesion, hemorrhage into the lesion, or compression of the adjacent tissues or organs. In other cases, pain is unexplained.

The only findings upon physical examination, seen infrequently, are an enlarged liver or the presence of an arterial bruit over the right upper quadrant.

Up to 40% of hepatic hemangiomas grow over time, at about a modest rate of 2 mm per year in linear dimension and 17.4% per year in volume, based on data from a 10-year retrospective study. [19] In a separate retrospective study, hemangiomas increased in size in 61.0% of patients, with the highest growth period in those younger than 30 years (0.46 ± 0.41 cm per year) and slowest growth period in those older than 50 years (0.16 ± 0.42 cm per year). [20] Hemangiomas sized 8-10 cm grew at a rate of 0.80 ± 0.62 cm per year, whereas those larger than 10 cm grew at a slower rate of 0.47 ± 0.91 cm per year. [20]

Rarely, hemangiomas may present as a large abdominal mass. Other atypical presentations include the following: (1) cardiac failure from massive arteriovenous shunting, (2) jaundice from compression of the bile ducts, (3) gastrointestinal bleeding from hemobilia, [21] and (4) fever of unknown origin. [22]

An illness that resembles a systematic inflammatory process has been described with the findings of fever, weight loss, anemia, thrombocytosis, increased fibrinogen level, and elevated erythrocyte sedimentation rate. [23]

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