Pediatric Radiology

, Volume 42, Issue 3, pp 298–307 | Cite as

Hepatic haemangioma—prenatal imaging findings, complications and perinatal outcome in a case series

  • Stephanie Franchi-Abella
  • Gillaume Gorincour
  • Freddy Avni
  • Laurent Guibaud
  • Laurent Chevret
  • Danièle Pariente
  • SFIPP-GRRIF (Société Francophone d’Imagerie Pédiatrique et Périnatale-Groupe de Recherche Radiopédiatrique en Imagerie Foetale)
Original Article



The clinical presentation of foetal hepatic haemangioma (HH) is highly variable, from asymptomatic to life-threatening.


The aim of this study was to describe foetal hepatic haemangioma and identify prognostic factors.

Materials and methods

Antenatal and postnatal imaging studies, clinical and biological records of infants with antenatally diagnosed HH (2001—2009) were reviewed.


Sixteen foetuses had one focal lesion, with a mean volume of 75 ml (5–240 ml). One had multifocal HH. Most presented as a focal well-delimited heterogeneous vascular mass. Four had associated cardiomegaly, five had cardiac failure. Eight of the nine foetuses with cardiac disorders were symptomatic at birth: cardiac failure with pulmonary hypertension (9), consumptive coagulopathy (8), compartmental syndrome (2). All received supportive medical treatment, four embolisation. Five of these died. The remaining eight had a normal cardiac status. Two became symptomatic after birth: one with a large porto-hepatic shunt and one with significant mass effect. Prenatal cardiac abnormality (univariate, P = 0.031), enlargement of more than one hepatic vein (P = 0.0351) and large volume (P = 0.0372) were associated with symptomatic disease.


Hepatic haemangioma associated with prenatal cardiac disorders, large volume and more than one enlarged hepatic vein have poorer outcome and require specific perinatal multidisciplinary management.


Prenatal diagnosis Liver Haemangioma Tumour 



We would like to thank the following colleagues for referring cases for the study: Dr. Belarbi, Dr. Couture, Dr. Eurin, Dr. Eyrault, Dr. Faure, Dr. Ftouki, Dr. Garel, Dr. Marouteau, Dr. Rozel, and Dr. Zirah.


  1. 1.
    Mulliken JB, Enjolras O (2004) Congenital hemangiomas and infantile hemangioma: missing links. J Am Acad Dermatol 50:875–882PubMedCrossRefGoogle Scholar
  2. 2.
    North PE, Waner M, Mizeracki A et al (2000) GLUT1: a newly discovered immunohistochemical marker for juvenile hemangiomas. Hum Pathol 31:11–22PubMedCrossRefGoogle Scholar
  3. 3.
    Isaacs H Jr (2007) Fetal and neonatal hepatic tumors. J Pediatr Surg 42:1797–1803PubMedCrossRefGoogle Scholar
  4. 4.
    Hughes JA, Hill V, Patel K et al (2004) Cutaneous haemangioma: prevalence and sonographic characteristics of associated hepatic haemangioma. Clin Radiol 59:273–280PubMedCrossRefGoogle Scholar
  5. 5.
    Dickie B, Dasgupta R, Nair R et al (2009) Spectrum of hepatic hemangiomas: management and outcome. J Pediatr Surg 44:125–133PubMedCrossRefGoogle Scholar
  6. 6.
    Metry DW, Hawrot A, Altman C et al (2004) Association of solitary, segmental hemangiomas of the skin with visceral hemangiomatosis. Arch Dermatol 140:591–596PubMedCrossRefGoogle Scholar
  7. 7.
    Draper H, Diamond IR, Temple M et al (2008) Multimodal management of endangering hepatic hemangioma: impact on transplant avoidance: a descriptive case series. J Pediatr Surg 43:120–125, discussion 126PubMedCrossRefGoogle Scholar
  8. 8.
    Kassarjian A, Zurakowski D, Dubois J et al (2004) Infantile hepatic hemangiomas: clinical and imaging findings and their correlation with therapy. Am J Roentgenol 182:785–795Google Scholar
  9. 9.
    Leaute-Labreze C, Taieb A (2008) Efficacy of beta-blockers in infantile capillary haemangiomas: the physiopathological significance and therapeutic consequences. Ann Dermatol Venereol 135:860–862PubMedCrossRefGoogle Scholar
  10. 10.
    Christison-Lagay ER, Burrows PE, Alomari A et al (2007) Hepatic hemangiomas: subtype classification and development of a clinical practice algorithm and registry. J Pediatr Surg 42:62–67, discussion 67–68PubMedCrossRefGoogle Scholar
  11. 11.
    Marsciani A, Pericoli R, Alaggio R et al (2010) Massive response of severe infantile hepatic hemangioma to propanolol. Pediatr Blood Cancer 54:176PubMedCrossRefGoogle Scholar
  12. 12.
    Gonen R, Fong K, Chiasson DA (1989) Prenatal sonographic diagnosis of hepatic hemangioendothelioma with secondary nonimmune hydrops fetalis. Obstet Gynecol 73:485–487PubMedGoogle Scholar
  13. 13.
    Sepulveda WH, Donetch G, Giuliano A (1993) Prenatal sonographic diagnosis of fetal hepatic hemangioma. Eur J Obstet Gynecol Reprod Biol 48:73–76PubMedCrossRefGoogle Scholar
  14. 14.
    Morris J, Abbott J, Burrows P et al (1999) Antenatal diagnosis of fetal hepatic hemangioma treated with maternal corticosteroids. Obstet Gynecol 94:813–815PubMedCrossRefGoogle Scholar
  15. 15.
    Dreyfus M, Baldauf JJ, Dadoun K et al (1996) Prenatal diagnosis of hepatic hemangioma. Fetal Diagn Ther 11:57–60PubMedCrossRefGoogle Scholar
  16. 16.
    Meirowitz NB, Guzman ER, Underberg-Davis SJ et al (2000) Hepatic hemangioendothelioma: prenatal sonographic findings and evolution of the lesion. J Clin Ultrasound 28:258–263PubMedCrossRefGoogle Scholar
  17. 17.
    Gembruch U, Baschat AA, Gloeckner-Hoffmann K et al (2002) Prenatal diagnosis and management of fetuses with liver hemangiomata. Ultrasound Obstet Gynecol 19:454–460PubMedCrossRefGoogle Scholar
  18. 18.
    Ritter S, Jorn H, Ahaus M et al (2003) Prenatal diagnosis of hepatic hemangioendothelioma and peripartual management. Z Geburtshilfe Neonatol 207:29–32PubMedCrossRefGoogle Scholar
  19. 19.
    Morimura Y, Fujimori K, Ishida T et al (2003) Fetal hepatic hemangioma representing non-reassuring pattern in fetal heart rate monitoring. J Obstet Gynaecol Res 29:347–350PubMedCrossRefGoogle Scholar
  20. 20.
    Hsiao KH, Lin LH, Chen DF et al (2007) Hepatic mesenchymal hamartoma combined with infantile hepatic hemangioendothelioma in an infant. J Formos Med Assoc 106:S1–S4PubMedCrossRefGoogle Scholar
  21. 21.
    Schmitz R, Heinig J, Klockenbusch W et al (2009) Antenatal diagnosis of a giant fetal hepatic hemangioma and treatment with maternal corticosteroid. Ultraschall Med 30:223–226PubMedCrossRefGoogle Scholar
  22. 22.
    Dong SZ, Zhu M, Zhong YM et al (2010) Use of foetal MRI in diagnosing hepatic hemangioendotheliomas: a report of four cases. Eur J Radiol 75:301–305PubMedCrossRefGoogle Scholar
  23. 23.
    Chang LC, Haggstrom AN, Drolet BA et al (2008) Growth characteristics of infantile hemangiomas: implications for management. Pediatrics 122:360–367PubMedCrossRefGoogle Scholar
  24. 24.
    Capelle X, Syrios P, Chantraine F et al (2009) A rare case of placental chorioangioma associated with neonatal disseminated hemangiomatosis. J Gynecol Obstet Biol Reprod 38:246–249CrossRefGoogle Scholar
  25. 25.
    Acharya S, Jayabose S, Kogan SJ et al (1997) Prenatally diagnosed neuroblastoma. Cancer 80:304–310PubMedCrossRefGoogle Scholar
  26. 26.
    Mariotti V, Marconi AM, Pardi G (2004) Undesired effects of steroids during pregnancy. J Matern Fetal Neonatal Med 16(S2):5–7PubMedGoogle Scholar
  27. 27.
    Mari G, Deter RL, Carpenter RL et al (2000) Noninvasive diagnosis by Doppler ultrasonography of fetal anemia due to maternal red-cell alloimmunization. Collaborative Group for Doppler assessment of the blood velocity in anemic fetuses. N Engl J Med 342:9–14PubMedCrossRefGoogle Scholar
  28. 28.
    Leaute-Labreze C, Dumas de la Roque E, Hubiche T et al (2008) Propranolol for severe hemangiomas of infancy. N Engl J Med 358:2649–2651PubMedCrossRefGoogle Scholar
  29. 29.
    Some Nina K, Lorette G, Chantepie A et al (2004) Hypertrophic cardiomyopathy associated with oral corticosteroid therapy for palpebral hemangioma. Ann Dermatol Venereol 131:263–265PubMedCrossRefGoogle Scholar
  30. 30.
    Rossler J, Wehl G, Niemeyer CM (2008) Evaluating systemic prednisone therapy for proliferating haemangioma in infancy. Eur J Pediatr 167:813–815PubMedCrossRefGoogle Scholar
  31. 31.
    Frieden IJ, Drolet BA (2009) Propranolol for infantile hemangiomas: promise, peril, pathogenesis. Pediatr Dermatol 26:642–644PubMedCrossRefGoogle Scholar
  32. 32.
    Grimal I, Duveau E, Enjolras O et al (2000) Effectiveness and dangers of interferon-alpha in the treatment of severe hemangiomas in infants. Arch Pediatr 7:163–167PubMedCrossRefGoogle Scholar
  33. 33.
    Perez Payarols J, Pardo Masferrer J, Gomez Bellvert C (1995) Treatment of life-threatening infantile hemangiomas with vincristine. N Engl J Med 333:69PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Stephanie Franchi-Abella
    • 1
  • Gillaume Gorincour
    • 2
  • Freddy Avni
    • 3
  • Laurent Guibaud
    • 4
  • Laurent Chevret
    • 5
  • Danièle Pariente
    • 1
  • SFIPP-GRRIF (Société Francophone d’Imagerie Pédiatrique et Périnatale-Groupe de Recherche Radiopédiatrique en Imagerie Foetale)
  1. 1.Pediatric RadiologyHopital BicêtreLe Kremlin BicêtreFrance
  2. 2.Pediatric RadiologyCHU La Timone-Enfants APHMMarseilleFrance
  3. 3.Pediatric RadiologyErasme University HospitalBrusselsBelgium
  4. 4.Pediatric and Fetal ImagingHôpital Femme Mère EnfantLyon BronFrance
  5. 5.Pediatric Intensive Care UnitHopital BicêtreLe Kremlin BicêtreFrance

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