Cavernous Hemangioma

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1- Introduction

2- Clinical Features & Examination Tips

3- Investigations & Interpretation

4- Pathophysiology

5- Symptoms

6- Treatment

Introduction

A cavernous hemangioma is the most common benign tumour of the liver, often detected incidentally during imaging. These vascular lesions are typically small, asymptomatic, and slow-growing. Although common, they rarely cause clinical problems and seldom require intervention.

© image from Wikimedia Commons

Clinical Features & Examination Tips

Most patients are asymptomatic and have normal physical examination findings.

 If large (>5 cm), it may cause:

  • Right upper quadrant discomfort or pressure

  • Palpable mass (rare)

  • Nonspecific GI symptoms (nausea, bloating)

Tip for OSCE/Clerking: If liver edge is palpable but the patient is well and LFTs are normal, consider a benign lesion like hemangioma in your differential.

Investigations & Interpretation

Biochemistry:

  • Liver function tests (LFTs) are normal.

Imaging (key to diagnosis):

  • Ultrasound: Hyperechoic, well-circumscribed lesion

  • CT scan: Shows peripheral nodular enhancement with centripetal fill-in

  • MRI: Most specific; T2 hyperintense lesion with classic fill-in pattern

Biopsy is contraindicated due to risk of bleeding.

Pathophysiology

Cavernous hemangiomas are congenital vascular malformations, made of blood-filled vascular channels lined by endothelium. These lesions are non-neoplastic and grow slowly. The surrounding liver parenchyma remains unaffected. Estrogen may promote growth, which is why hemangiomas are more frequently diagnosed in women, especially during or after pregnancy.

Symptoms

  • Most cases are silent. When present, symptoms may include:

    • Right upper quadrant pain or discomfort

    • Feeling of fullness after meals

    • Rarely: complications such as bleeding, rupture, or Kasabach–Merritt syndrome (thrombocytopenia from platelet sequestration—extremely rare)

Treatment

-Observation is appropriate for:

  • Asymptomatic and typical lesions

  • Stable lesions on imaging

-Further management may be needed if:

  • Lesion is atypical, large, or causing pain

  • There’s uncertainty about diagnosis

  • Complications occur (very rare)

-Surgical resection is rarely indicated and only for:

  • Diagnostic uncertainty

  • Symptomatic large lesions

  • Risk of rupture or hemorrhage

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