What are the symptoms of hemangioma of the Liver? What are the causes of hemangi!


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The classically recognized hemangioma is a visible red skin lesion that may be in the top skin layers (capillary hemangioma), deeper in the skin (cavernous hemangioma), or a mixture of both.

Hemangiomas are usually present at birth, although they may appear within a few months after birth, often beginning at a site that has appeared slightly dusky or differently colored than the surrounding tissue.

Hemangiomas, both deep and superficial, undergo a rapid growth phase in which the volume and size increase rapidly. This phase is followed by a rest phase, in which the hemangioma changes very little, and an involutional phase in which the hemangioma begins to disappear.

During the involutional phase, hemangiomas may disappear completely. Large cavernous hemangiomas distort the skin around them and will ultimately leave visible changes in the skin. A superficial capillary hemangioma may involute completely, leaving no evidence of its past presence.

Hemangiomas may be present anywhere on the body. However, they are most disturbing to parents when they are on the infant's face or head. Hemangiomas of the eyelid may interfere with the development of normal vision and must be treated in the first few months of life. On rare occasions, the size and location of hemangiomas may interfere with breathing, feeding, or other vital functions. These lesions also require early treatment.

Large cavernous hemangiomas may develop secondary infections and ulcerate. Bleeding is common and may be significant following injury to the hemangioma.

Symptoms

A red to reddish-purple, raised lesion on the skin
A massive, raised tumor with blood vessels (a possibility)

Treatment

Superficial or "strawberry" hemangiomas often are not treated. When they are allowed to disappear on their own, the result is usuaully normal-appearing skin. In some cases, a laser may be used to eradicate the small vessels.

Cavernous hemangiomas that involve the eyelid and obstruct vision are generally treated with injections of steroids or laser treatments that rapidly reduce the size of the lesions, allowing normal vision to develop. Large cavernous hemangiomas or mixed hemangiomas are treated, when appropriate, with oral steroids and injections of steroids directly into the hemangioma.

Recently, lasers have been used to reduce the bulk of the hemangiomas. Lasers emitting yellow light selectively damage the vessels in the hemangioma without damaging the overlying skin. Some physicians are using a combination of steroid injection and laser therapy together.

Other Answers:
Hemangioma-Thrombocytopenia Syndrome (also known as Kasabach-Merritt Syndrome) is a rare disorder characterized by an abnormal blood condition in which the low number of blood platelets causes bleeding (thrombocytopenia). The thrombocytopenia is found in association with a benign tumor consisting of large, blood-filled spaces (cavernous hemangioma). The exact cause of this disorder is not known.
Source(s):
http://health.yahoo.com/topic/blood/overview/article/healthwise/nord992;_ylt=ApTMr6_bKKlaXk06sx66xAT3tMUF
Cavernous Hemangioma, Liver

Synonyms and related keywords: hepatic cavernous hemangioma,





MRI

Findings: MRI is more sensitive and specific than other imaging modalities in the diagnosis of hemangiomas. Hemangiomas appear as smooth, lobulated, homogeneous, sometimes septated, hypointense lesions on T1-weighted images. On T2-weighted images, they appear hyperintense relative to liver (more pronounced on fast spin-echo images), and they remain as bright as CSF or bile as the echo time (TE) is increased (McFarland, 1994) (see Image 3).

The high signal intensity on T2-weighted images is due to the extremely long T2 relaxation time of the free fluid (slowly moving blood). The T2 relaxation time is directly proportional to the collective size of the constituent vascular spaces (Tung, 1994). The T2 values of hemangiomas vary between 90 and 200 milliseconds compared with T2 values in cysts (>300 milliseconds).

Rarely, the imaging features of heavily fibrotic (hyalinized) hemangiomas can be mistaken for those of metastases (Cheng, 1995). With the injection of contrast material (gadolinium chelates), lesions typically demonstrate peripheral nodular enhancement with progressive, centripetal fill-in that usually appears after 5-30 minutes (see Image 4).

Large hemangiomas may appear cystic on images as a result of recurrent hemorrhage or myxomatous degeneration. In some hemangiomas, MRI may demonstrate fluid-fluid levels due to the sedimentation of blood products. The supernatant layer consists of unclotted serous blood, and the sediment consists of RBCs. Definitive diagnosis is often difficult (Soyer, 1998).

Degree of Confidence: MRI is more sensitive and specific than other imaging modalities in the diagnosis of hemangiomas. On the basis of liver hemangioma characteristics on T2-weighted images (both morphologic and quantitative T2 values), MRI has sensitivity, specificity, and accuracy rates of 100%, 92%, and 97%, respectively.

Hemangiomas that show early, homogeneous contrast enhancement at dynamic CT and/or MRI may be mistaken for other hypervascular liver tumors such as hepatoma, focal nodular hyperplasia, adenoma, and hypervascular metastases. The absence of a history of cirrhosis and/or primary malignancy is an important factor in diagnosing hemangioma. The characteristic features of a hemangioma on dynamic CT, RBC scintigraphy, and/or MRI permit confident diagnosis in more than 95% of cases.
ULTRASOUND
Findings: At ultrasonography, hemangiomas appear as well-circumscribed, uniformly hyperechoic lesions (see Image 5). The increased echogenicity is postulated to be caused by multiple interfaces between the walls of the cavernous spaces and the blood within them (McArdle, 1978). According to Taboury et al, more than 75% of hemangiomas also have posterior acoustic enhancement that is correlated with hypervascularity at angiography. In large hemangiomas, heterogeneous areas are interspersed within the hyperechoic mass. Atypical features include hypoechoic lesions with a thin hyperechoic rim or a thick rind and scalloped borders (Vilgrain, 2000). Hemangiomas may appear hypoechoic in fatty livers (Marsh, 1989).

Color power or duplex Doppler examinations have a limited role in the specific diagnosis of hemangioma (Perkins, 2000). Occasionally, a kilohertz shift in the low-to-mid range may be observed in the peripheral and central blood vessels in the hemangiomas.
NUCLEAR MEDICINE

Findings: RBC-tagged technetium-99m scintigraphy with single photon emission CT (SPECT) permits a specific diagnosis of hemangiomas (el-Desouki, 1999). The lesions characteristically show decreased activity on early dynamic images and delayed filling from the periphery of the lesion.

Degree of Confidence: The sensitivity, specificity, and accuracy of RBC-tagged 99mTc scintigraphy in the diagnosis of hemangiomas are 97%, 83%, and 96%, respectively.

Hemangiomas that show early, homogeneous contrast enhancement at dynamic CT and/or MRI may be mistaken for other hypervascular liver tumors such as hepatoma, focal nodular hyperplasia, adenoma, and hypervascular metastases. The absence of a history of cirrhosis and/or primary malignancy is an important factor in diagnosing hemangioma. The characteristic features of a hemangioma on dynamic CT, RBC scintigraphy, and/or MRI permit confident diagnosis in more than 95% of cases.
ANGIOGRAPHY

Findings: At angiography, the feeding vessels are of normal caliber, except those in large tumors. During the late arterial/hepatic parenchymal phases, a dense, nodular pattern of opacification of dilated vascular spaces persists into the venous phase (Kadir, 1986).

Degree of Confidence: Although hemangiomas have characteristic angiographic features, the use of angiography is not warranted in the diagnosis of hemangioma, given the diagnostic capabilities of less invasive techniques, such as helical CT and MRI.
INTERVENTION

Intervention: Most hemangiomas are asymptomatic and treated conservatively with watchful expectancy. Absolute indications for surgery include rupture, a rapid change in size, and the presence of Kasabach-Merritt syndrome (Gedaly, 1999; Hochwald, 2000). Large symptomatic hemangiomas are a relative indication for surgery. Surgical enucleation with blunt dissection is the preferred surgical technique; the surgical mortality and morbidity rates are negligible when an experienced surgeon performs the procedure. In symptomatic patients who are poor surgical candidates, transcatheter embolization is an attractive alternative (Cappellani, 2000; Kadir, 1986).


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