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. 2018 Jan 2;18(1):2.
doi: 10.1186/s12884-017-1635-7.

Huge fetal hepatic Hemangioma: prenatal diagnosis on ultrasound and prognosis

Li Jiao-Ling  1 , Geng Xiu-Ping  2 , Chen Kun-Shan  3 , He Qiu-Ming  4 , Li Xiao-Fen  2 , Yang Bo-Yang  2 , Fang Qian  2
Affiliations

Huge fetal hepatic Hemangioma: prenatal diagnosis on ultrasound and prognosis

Li Jiao-Ling et al. BMC Pregnancy Childbirth. .

Abstract

Background: Although huge fetal hepatic hemangiomas are rare, they can cause fatal complications. The purpose of this study is to describe the imaging features and prognosis of these tumors.

Methods: Imaging data were collected for 6 patients with huge fetal hepatic hemangiomas treated at our hospital. Imaging modalities included prenatal magnetic resonance imaging and ultrasound and postnatal color Doppler ultrasound and contrast-enhanced computed tomography (CT).

Results: Among the 93,562 fetuses of 92,126 pregnant women examined at our hospital, 6 had huge hepatic hemangiomas (incidence rate, 0.64/10,000), as confirmed via postnatal color Doppler imaging and contrast-enhanced CT. Five fetuses had solitary lesions, whereas 1 (fetus 2) had multiple lesions. Four fetuses had lesions in the right liver lobe and 1 had a lesion in the left liver lobe, and 1 (fetus 2) had lesions in both lobes. All lesions showed centripetal enhancement on postnatal contrast-enhanced CT, which was more intense peripherally. Following postnatal treatment with oral propranolol, with or without dexamethasone or interventional therapy with the medical sclerosant pingyangmycin, all lesions decreased in size, with calcification plaques appearing 6 months after treatment.

Conclusions: Huge hepatic hemangiomas have typical ultrasonographic features and can be diagnosed prenatally. Treatment with propranolol, with or without dexamethasone, may result in a favorable prognosis.

Keywords: Contrast-enhanced computed tomography; Huge hepatic hemangioma; Liver tumor; Magnetic resonance imaging; Prenatal diagnosis; Ultrasound.

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Conflict of interest statement

Ethics approval and consent to participate

This study was approved by the ethics committee of the GZ Women & Children Medical Centre. All pregnant women in the study provided informed consent for ultrasound. Written consent was obtained from participants in this study. (found in Additional file 1).

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

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Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Fetus with a hemangioma in the left liver lobe (fetus 1). a Circular hypoechoic lesion, measuring 86 × 81 × 103 mm. Color Doppler ultrasound shows a ring of blood flow at the edge of the lesion and stars intralesion. Pulse Doppler ultrasound suggests that the resistance index is 0.33. b Ultrasound on the day of birth shows that lesion has a clear border, an excentric growth pattern, and an internal grid-shaped region and bypasses the left hepatic vein. c Postnatal computed tomography (CT) shows the lesion in the left lobe. On contrast-enhanced CT, the lesion was centripetal enhancement. d Two years after treatment of the neonate with propranolol and dexamethasone, the lesion was 35 × 36 × 34 mm in size, with multiple strong echo spots in the center
Fig. 2
Fig. 2
Fetus with multiple hemangiomas in the whole liver (fetus 2). a Largest hypoechoic lesion, measuring 92 × 56 × 80 mm and located in the left liver lobe. Color Doppler ultrasound shows a ring of blood flow at the edge of the lesion and stars intralesion. Pulse Doppler ultrasound suggests that the resistance index is 0.42. b Ultrasound on the day of birth shows that the large lesion has a clear border and an internal grid-shaped region. The portal vein was unobstructed, and its inner diameter was normal. c Postnatal computed tomography (CT) shows the large lesion in the left lobe and several smaller lesions in the right lobe. The density of the mass was low but not uniform. On contrast-enhanced CT, the edge of the lesion increased in intensity in a lattice-like pattern in the early phase of the scan, and the center of the mass gradually increased in intensity during the delay phase; there was no enhancement in the low-density zone. d Two years after treatment of the neonate with propranolol and dexamethasone, the lesion was 19 × 19 × 10 mm in size. Calcification plaques were observed in the lesion, and the intrahepatic and the extrahepatic bile ducts were not dilated
Fig. 3
Fig. 3
Fetus with a hemangioma in the right liver lobe (fetus 4). a Hypoechoic lesion measuring 56 × 42 × 41 mm. Color Doppler ultrasound shows a strip of blood flow at the edge of the lesion and stars intralesion. Pulse Doppler ultrasound suggests that the resistance index is 0.53. b Ultrasound on the day of birth shows that the lesion is less clear, with nonuniform density and punctate calcifications. The hepatic vein was bypassed. c Postnatal computed tomography (CT) shows nonuniform density and punctate calcifications. On contrast-enhanced CT, the lesion was centripetal enhancement. It was supplied by a branch of the hepatic artery and drained via the hepatic veins; the right and middle hepatic veins were thickened. d Six months after treatment of the neonate with propranolol and dexamethasone, the lesion was 28 × 25 × 27 mm in size. Calcification plaques were observed, and the intrahepatic and the extrahepatic bile ducts were not dilated
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