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Hemangioma of the liver: causes, symptoms, diagnosis, treatment
Last reviewed: 07.07.2025
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Hemangioma of the liver is the most common benign liver tumor. It is found in 5% of autopsies. The wider use of liver scanning methods helps to improve the diagnosis of this tumor. Hemangiomas are usually solitary and small in size, but sometimes they are large and multiple.
Typically, hepatic hemangioma is located subcapsularly, under the diaphragmatic surface of the right lobe of the liver and sometimes has a stalk. In section, it has a round or wedge-shaped form, a dark red color and resembles a honeycomb; the fibrous capsule of the tumor may contain foci of calcification. Histological examination reveals a network of branched communicating spaces containing erythrocytes. Blood coagulation factor VIII may be expressed on tumor cells.
The tumor cells are lined with flat endothelial cells and contain a small amount of connective tissue, although in some cases it can be significant.
[ Symptoms of liver hemangioma
In most patients, liver hemangioma is asymptomatic and is diagnosed by chance. In giant hemangiomas (more than 4 cm in diameter), they can often be palpated; pain may occur due to tumor thrombosis.
Symptoms of compression of adjacent organs by the tumor are possible. Vascular noise is occasionally heard over the hemangioma.
Where does it hurt?
Diagnosis of liver hemangioma
On plain radiographs, a calcified capsule can be seen.
Ultrasound reveals a solitary echogenic formation with smooth, well-defined contours. The acoustic signal is typically enhanced when passing through the blood in the cavernous sinuses.
In contrast-enhanced CT, accumulation of contrast agent in the venous bed of the tumor in the form of puddles is noted. It diffuses from the peripheral areas to the center, and after 30-60 minutes the darkening becomes homogeneous. In dynamic CT after intravenous jet injection of contrast agent, globular darkening areas are visible. Calcification may be detected, which is a consequence of previous bleeding or thrombus formation.
On magnetic resonance imaging, the tumor appears as an area of high signal intensity. The T2 relaxation time exceeds 8 ms. MRI is especially valuable in diagnosing small hemangiomas.
Single-photon emission CT with 99mTc -labeled red blood cells reveals prolonged retention of radioactivity over the tumor due to blood retention in it.
Angiography is indicated only when CT fails to confirm the diagnosis. The tumor displaces the large hepatic arteries to one side. They are not enlarged, and narrow as usual as the branches extend. The cavernous spaces of the tumor filled with contrast agent are shaped like a ring or semicircle due to fibrosis of the central areas. In hemangiomas, the contrast agent may be retained for up to 18 seconds.
Liver biopsy (targeted). Liver biopsy with a fine needle is usually safe, but there is no need for it due to the sufficient information content of visualization methods of examination.
What do need to examine?
Treatment of liver hemangioma
Treatment of liver hemangioma is usually not required, since the tumor does not increase in size and clinical symptoms do not increase. The possibility of tumor rupture is not an indication for surgical intervention. In case of severe pain syndrome or rapid growth of liver hemangioma, liver resection is used, which usually consists of lobetomy or segmentectomy.