Liver Hemangiomas: Diagnosis, Monitoring, and Concerns

Hepatic hemangioma issues?

In August 2018, an abdominal ultrasound at the clinic revealed a 2.2 cm liver tumor, mild fatty liver, and a 0.4 cm gallbladder polyp.
Tests for hepatitis B and C were conducted, and both liver function tests and alpha-fetoprotein (cancer marker) were normal.
Subsequently, a CT scan at the hospital confirmed a diagnosis of hepatic hemangioma.
Follow-up was scheduled every three months, and after four follow-ups, there were no changes.
In December 2019, during the next follow-up, the doctor informed that the original hemangioma had not changed, but two additional shadows were detected (the patient had lost approximately 10 kg from June to December 2019).

Questions:
1.
Can hemangiomas increase in number?
2.
Is it possible that after several ultrasounds and CT scans, the other two shadows were not detected? Could they be something concerning?
3.
Could the weight loss have caused uneven fat distribution, leading to the appearance of these shadows?

Kum, 40~49 year old female. Ask Date: 2019/12/17

Dr. Chen Shidian reply Gastroenterology and Hepatology

1.
Rarely increases.
2.
Not often missed.
3.
Common artifacts; please cooperate with follow-up.

Reply Date: 2019/12/17

More Info

Liver hemangiomas are the most common benign tumors of the liver, and they are often discovered incidentally during imaging studies such as ultrasound or CT scans. Your case presents several important points regarding the diagnosis, monitoring, and concerns associated with liver hemangiomas.

1. Can hemangiomas multiply?
While it is uncommon for hemangiomas to increase in number, it is not impossible. Hemangiomas are vascular lesions, and their growth can be influenced by various factors, including hormonal changes and individual body responses. In some cases, new hemangiomas may develop, but this is relatively rare. The majority of hemangiomas remain stable in size and do not require treatment unless they cause symptoms or complications.

2. Could the additional shadows be missed in previous ultrasounds and CT scans?
Yes, it is possible for small lesions to be missed during imaging studies. The sensitivity of ultrasound and CT scans can vary based on the size, location, and characteristics of the lesions. Smaller lesions, particularly those less than 1 cm, may not be easily detected. Additionally, the quality of the imaging technique and the experience of the radiologist can also play a significant role in the detection of liver lesions. The newly identified shadows could represent other benign conditions, such as cysts or new hemangiomas, but they could also be indicative of more serious issues. Therefore, further evaluation is warranted.

3. Could weight loss cause uneven fat distribution and result in shadows?
Weight loss can indeed lead to changes in liver morphology and fat distribution. In some cases, significant weight loss can alter the appearance of the liver on imaging studies, potentially leading to the appearance of new shadows. However, it is essential to differentiate between benign changes and potential pathological conditions. The shadows could be related to changes in liver fat content or even new lesions that require further investigation.

Given your history of liver hemangiomas and the recent discovery of additional shadows, it is crucial to follow up with your healthcare provider. They may recommend further imaging studies, such as an MRI, which can provide more detailed information about the nature of the new lesions. MRI is particularly useful for characterizing liver lesions due to its superior soft tissue contrast compared to CT.

In conclusion, while liver hemangiomas are generally benign and stable, any new findings warrant careful evaluation. Regular monitoring, as you have been doing, is essential, and any changes in your health or imaging results should be discussed with your healthcare provider. They can provide personalized recommendations based on your specific situation and ensure that any potential issues are addressed promptly.

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