Hepatic hemangioma

Updated January 29, 2024

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of hepatic hemangioma are prepared by our editorial team based on guidelines from the European Association for the Study of the Liver (EASL 2023,2016), the American College of Radiology (ACR 2020), the European Federation of Societies for Ultrasound (EFSU 2020), and the American College of Gastroenterology (ACG 2016,2014).

Diagnostic investigations

Contrast-enhanced ultrasound

As per ACR 2020 guidelines:

Obtain contrast-enhanced abdominal ultrasound of an indeterminate > 1 cm liver lesion on initial ultrasound in patients with a normal liver with no suspicion or evidence of extrahepatic malignancy or underlying liver disease.

Obtain contrast-enhanced abdominal ultrasound of an incidental liver lesion > 1 cm on initial ultrasound, non-contrast or single-phase CT, or non-contrast MRI in patients with known chronic liver disease.

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Diagnostic procedures

Liver biopsy: as per ACG 2014 guidelines, avoid performing a liver biopsy in the presence of radiologic features suggestive of hepatic hemangioma.

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Medical management

Indications for treatment: as per EASL 2016 guidelines, offer conservative management in patients with typical cases of hepatic hemangioma.

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Specific circumstances

Pregnant patients

As per EASL 2023 guidelines:

Counsel female patients that hemangiomas (even giant hemangiomas) do not preclude pregnancy.

Obtain imaging during each trimester of pregnancy to monitor hemangioma size in patients at higher risk of rupture (large or exophytic).

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Patient education

General counseling: as per EASL 2016 guidelines, counsel patients that pregnancy and the use of oral contraceptives are not contraindicated in hepatic hemangioma.

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Follow-up and surveillance

Indications for referral: as per EASL 2016 guidelines, refer patients to benign liver tumor multidisciplinary team in the presence of Kasabach-Merrit syndrome, growing lesions, or lesions symptomatic by compression.

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