Management of liver hemangiomas according to size and symptoms

Background and Aim: Liver hemangiomas are the most common benign liver tumors. These lesions are usually incidental findings during imaging studies of the abdomen performed for other reasons. The indication for surgical resection of these lesions remains controversial. Methods: Records of patients referred for evaluation of radiologically and/or histopathologically proven liver hemangiomas, from June 1991 to February 2006, were retrospectively analyzed. Reason for referral, results of imaging studies, and surgical treatment and outcome were reviewed. Results: There were 34 patients identified. The hemangioma size was < 5 cm in 15 patients (44%) and > 5 cm in 19 patients. The most common reason for referral was right upper abdominal pain in 59% (20/34) of patients. Abdominal ultrasound was conclusive in 66.7% (16/24) and four-phase computed tomography (CT) in 82.6% (19/23) of patients. Surgical resection was undertaken in 14 patients (41%) after a mean follow-up time of 36.5 months. The indication for treatment was progressive abdominal pain in 78.6% (11/14). Mean size of resected lesions was larger compared to non-resected lesions (10.3 vs 4.8 cm; P = 0.004). Postoperative morbidity occurred in three patients (21.4%). One patient had persisting abdominal pain after resection of an 8-cm hemangioma. Twenty patients were observed and showed no complications related to the liver hemangioma during follow-up. Conclusions: Liver hemangiomas can be readily diagnosed by ultrasound or multiphase contrast-enhanced helical CT. The indications for surgical resection are progressive abdominal pain in combination with size > 5 cm. Observation is justified in patients with minimal or no symptoms, even in patients with giant hemangiomas.