Schnelldorfer et al evaluated patients with giant hemangiomas of the liver. They identified patients who may benefit from operative management. The authors are from the Mayo Clinic.


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


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