A giant hemangioma of the liver is defined as an hemangioma with a diameter > 4 cm. Hepatic hemangiomas may be > 14 cm in diameter. Some patients may have multiple hemangiomas, not all of which are giant.
Most patients with giant hemangiomas do not need to have the hemangioma resected and can be simply observed. A patient may be a candidate for operative mangement if symptoms are severe or complications develop.
Symptoms associated with a giant hepatic hemangioma:
(1) abdominal pain
(2) ascites
(3) chronic nausea and vomiting
(4) jaundice
Complications associated with a giant hepatic hemangioma:
(1) intra-abdominal hemorrhage
(2) hemobilia
(3) Kasabach-Merritt syndrome with thrombocytopenia
(4) hemangioma-associated heart failure
Size alone is not an indication for surgical resection.
Additional reasons to consider operative management (not suggested by the authors):
(1) a person at high risk for blunt or penetrating abdominal trauma, such as an athlete participating in a contact sport
(2) a person with a very large hemangioma who may not have access to adequate medical facilities
