Hepatic Angioma

Hepatic angioma or hemangioma is the most frequent benign hepatic neoformation in the general population, and it can present at all ages. In women it has an incidence of about 6 times higher than in men, and like the adenoma, its growth increases during pregnancy. They are single or multiple nodules, generally 1-3cm in diameter, although some can reach 10-20cm in size. Some angiomas may be associated with similar lesions in other organs. They are made up of a network of capillary channels filled with blood and fibrous tissue that separate it from the surrounding liver tissue.
Less frequently, cavernous hemangioma is found, with a more convoluted and complex appearance compared to a simple angioma, it is usually present from birth or in childhood and can reach considerable dimensions. The dilation of the vascular spaces causes an increase in the volume of the angioma over time, which is why angiomas with a long evolution time almost always acquire a cavernous appearance.
The vast majority of patients are asymptomatic. However, angiomas larger than 4-5 cm in diameter can cause pain and a sensation of heaviness, accompanied by a palpable mass in the right hypochondrium. The presence of angioma can be evidenced by the appearance of complications, the most frequent being thrombosis and spontaneous rupture of the angioma (a very rare event) or after trauma.
The diagnosis of hepatic angioma is made after a radiological examination carried out for another reason (incidental diagnosis). They can be seen as well-demarcated areas that are irregular in appearance from the surrounding liver by ultrasound, CT (computed tomography) and MRI (magnetic resonance imaging). In cases of diagnostic doubt, selective angiography of the common hepatic artery may be necessary.
No cases of malignant degeneration of the hemangioma have been reported, however periodic check-ups are recommended, since they may suffer a slow and progressive increase in volume. Although rarely, angiomas can increase in size during pregnancy, so repeat ultrasounds are recommended to monitor any developments.
The vast majority of cases are asymptomatic, therefore, angiomas generally do not need to be treated. However, the presence of symptoms, the risk of rupture, and the large dimensions of the mass are an indication for surgery, which consists of removal of the angioma with possible resection of the liver parenchyma around the lesion. If there are contraindications to surgery (such as severe cardiac or pulmonary pathologies, advanced age), alternative treatments to surgery are embolization of the arterial branches afferent to the angioma, radiotherapy, and ligation of the branch of the hepatic artery afferent to the angioma.