68 years old hypertensive for 2 years presented with a increasing mass in the epigastric region for over one and half years. CT is showing large hemangioma in left lobe of the liver. Is embolisation having any role or straight away resection?
Embolisation of a so large mass can leads to ischemic problem an than suppurative complications.
Resection if pt symptomatic, however a period of observation and monitoring size may be a safer option
I would like to select resection or enucleation of the giant hemangioma locating in the left lobe. After occlusion of the hepatic inflow by Pringle manuver, the giant hemangioma will be shrinked, so as to facilitate the surgical procedures.
The lesion is quite big and located in the left lobe. Even if the patient is not symptomatic, I think surgery is the best option. Considering its location in the left lobe I will prefer resection over enucleation.
It is unlikely an hemangioma as these only occur in infants. This is most likely a large vascular malformation to use ISSVA terminology. Embolization with glue followed by resection is likely the ideal approach..
I will also say that since the lesion is in the left lobe it should be operated because the left lobe lesions ,as we have learnt from experience that liver abscesses of the left lobe tends to rupture more often than lesions in the right. This happens because tghe left lobe lesions are relatively less supported either by liver or the rib cage.
You can use radiofrequencyl ablation..If the patienet is symptomatic or embolization . If the patient is asymptomatic I do nothing.
I don't think radiofrequency ablation is possible for a large lesion like this one. While small haemangioma can be observed, it is not a good practice for a large tumour like this patient has. Apart from rupture (more frequent in unsupported left lobe). problems of consumption coagulopathy is also a point to be considered in large haemangiomas.
Rupture, and malignization are not frequent complications. May be the increasing size can be a indication of embolization, RFA or surgery but it can be a matter of disussion.
What is changing in indications and treatment of hepatic hemangiomas. A review.Toro A, Mahfouz AE, Ardiri A, Malaguarnera M, Malaguarnera G, Loria F, Bertino G, Di Carlo I. Ann Hepatol. 2014 Jul-Aug;13(4):327-39. Review.PMID: 24927603
I insist that the point is symptomatic vs asymptomatic hemangiomas.To treat (symptomatic) or not to treat (asymptomatic. There are in the literatura the posibility of RF ablation in large hemangiomas. But in the literature are not poininte out if thy treat all large hemangiomas or only symptomatic. The only las paper questioned this ítem (
I agree. Treat if symptomatic. A tumour that size I would suggest left lobectomy
For this case of symptomatic hemangioma, I think that the best treatment is a laparoscopic left lobectomy
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