Hepatic hemangiomas in children: potential risks and principles of treatment
Keywords:hepatic hemangiomas, infantile hemangiomas, hypothyroidism, propranolol
Purpose. Clinical manifestations of hepatic hemangiomas (HH) range from asymptomatic lesions to congestive heart failure associated, hepatic failure, hypothyroidism, and death.
The aim of study is to review our experience in the management of HH in children.
Methods. Fifteen patients during period 2011–2019 were diagnosed with HH as follows: 2 focal, 9 multiple and 4 diffuse lesions. All patients were screened for heart failure and hypothyroidism. The median age at diagnosis was 52.3±43.3 days. To clarify the diagnosis, MRI (n=5), CT (n=10), liver biopsy with Glut1 protein (n=1) performed.
Result. Heart failure complicated the course of HH in 3 (20.0%), hepatic immaturity in 5 (33.3%), and hypothyroidism in three (20.0%) patients. Treatment with propranolol was performed in 12 patients 4 with diffuse HH and 8 with multifocal HH), duration of therapy was 6 to 24, on average 14.9±4.3 months. Broncho-obstructive syndrome, with the need to discontinue treatment, occurs in one case (8.3%). One child with multifocal HH died of progressive heart failure, the mortality rate is 6.7%. In 8 children with multifocal HH treated with propranolol, the involution occurred at the age of 6–18 months. In children with diffuse HH there were residual lesions in diameter up to 2 cm (n=2). Children with hypothyroidism were substitution therapy with L-thyroxine. Treatment with focal HHs has not been performed, and their involution has been observed for 9 and 15 months.
Conclusion. Hepatic hemangiomas (HH) represent a diverse spectrum of clinical presentations and high potential of severe complication. Early treatment with beta-blockers of symptomatic HH and careful monitoring of asymptomatic patients can prevent complications and reduce mortality.
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