Hepatic Hemangioma

Hepatic hemangioma is the MOST COMMON benign liver tumour, a congenital vascular malformation (cavernous venous channels) with NO malignant potential. For Zambian students, it is a FREQUENT INCIDENTAL FINDING on ultrasound. Recognition prevents unnecessary anxiety, biopsy (haemorrhage risk), and surgery. PATHOPHYSIOLOGY: Benign, non-neoplastic. Endothelial-lined vascular channels, slow-flow. Size: small (<5cm), giant (>10cm). CLINICAL: INCIDENTAL (90%), all ages, female predominance. Asymptomatic. GIANT HEMANGIOMA: abdominal pain, early satiety, palpable mass. RARE COMPLICATIONS: Kasabach-Merritt syndrome (consumptive coagulopathy—thrombocytopenia, hypofibrinogenaemia), spontaneous rupture (EXQUISITELY RARE, <1%). NO malignant transformation. DIAGNOSIS: ULTRASOUND: HYPERECHOIC, HOMOGENEOUS, WELL-DEFINED, posterior acoustic enhancement (bright). SMALL (<3cm) → DIAGNOSTIC. ATYPICAL: giant, heterogeneous, isoechoic, calcification. CONTRAST-ENHANCED ULTRASOUND (CEUS): peripheral nodular enhancement, CENTRIPETAL FILL-IN. CONTRAST-ENHANCED CT/MRI: DIAGNOSTIC. CT: hypodense, arterial phase: PERIPHERAL, NODULAR, DISCONTINUOUS ENHANCEMENT (same as aorta), PORTAL VENOUS/DELAYED: CENTRIPETAL FILL-IN, ISODENSE. MRI: T2: MARKED HYPERINTENSE ('light bulb' sign). Management: INCIDENTAL, TYPICAL: NO TREATMENT. REASSURE. NO SURVEILLANCE. GIANT, SYMPTOMATIC: RESECTION (enucleation) or INTERVENTION (rarely needed). Rupture: EMERGENCY, haemodynamic support, resection/embolization. Kasabach-Merritt: corticosteroids, interferon, resection. AVOID: BIOPSY (risk of major haemorrhage). OCP: NO contraindication. Pregnancy: safe (growth rare). Prognosis: EXCELLENT. Zambian context: HEMANGIOMA IS EXTREMELY COMMON. Ultrasound is widely available—TYPICAL APPEARANCE (hyperechoic, homogeneous, well-defined) is DIAGNOSTIC. Do NOT biopsy. Do NOT refer. Do NOT follow-up. REASSURE patient. This is one of the most important benign diagnoses to recognize and prevent iatrogenic harm. ATYPICAL FEATURES: heterogeneous, isoechoic, large size, calcification—requires CONFIRMATORY IMAGING (CEUS, CT, MRI) available at tertiary centres. MRI is diagnostic. Giant symptomatic haemangioma: surgical resection available (tertiary). This is RARE. MASTER HEPATIC HEMANGIOMA: RECOGNIZE, REASSURE, DO NOT BIOPSY, DO NOT FOLLOW.