Multifocal infantile hepatic hemangiomas—imaging strategy and response to treatment after propranolol and steroids including review of the literature


Infantile hepatic hemangioma is the most common benign liver tumor during infancy. Prompt diagnosis and timely institution of therapy are of utmost importance. Magnetic resonance imaging (MRI) plays a key role in the correct diagnosis and monitoring of treatment. We report on a 15-week-old girl with multifocal infantile hemangiomas of the liver and high output congestive heart failure. Diagnosis was confirmed by MRI. Subsequent treatment with propranolol and steroids showed dramatic regression of the lesions within 24 weeks. We present the characteristic MRI findings and discuss treatment options together with a comprehensive review of the relevant literature.

Conclusion Propranolol appears highly efficacious in the management of infantile hepatic hemangioma; dedicated MRI is essential in confirming the diagnosis and monitoring of treatment.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Scheme 1
Fig. 3
Fig. 4


  1. 1.

    Boon LM, Burrows PE, Paltiel HJ, Lund DP, Ezekowitz RA, Folkman J, Mulliken JB (1996) Hepatic vascular anomalies in infancy: a twenty-seven-year experience. J Pediatr 129(3):346–354

    PubMed  Article  CAS  Google Scholar 

  2. 2.

    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 42:62–66

    PubMed  Article  Google Scholar 

  3. 3.

    Léauté-Labrèze C, Dumas de la Roque E, Hubiche T, Boralevi F, Thambo JB, Taïeb A (2008) Propranolol for severe hemangiomas of infancy. N Engl J Med 358:2649–2651

    PubMed  Article  Google Scholar 

  4. 4.

    Mazereeuw-Hautier J, Hoeger PH, Benlahrech S et al (2010) Efficacy of propranolol in hepatic infantile hemangiomas with diffuse neonatal hemangiomatosis. J Pediatr 157(2):340–342

    PubMed  Article  Google Scholar 

  5. 5.

    Mhanna A, Franklin WH, Mancini AJ (2011) Hepatic infantile hemangiomas treated with oral propranolol—a case series. Pediatr Dermatol 28(1):39–45

    PubMed  Article  Google Scholar 

  6. 6.

    Mulliken JB, Glowacki J (1982) Hemangiomas and vascular malformations in infants and children: a classification based on endothelial characteristics. Plast Reconsr Surg 69(3):412–422

    Article  CAS  Google Scholar 

  7. 7.

    Sarialioglu F, Erbay A, Demir S (2010) Response of infantile hepatic hemangioma to propranolol resistant to high-dose methylprednisolone and interferon-α therapy. Pediatr Blood Cancer 55(7):1433–1434

    PubMed  Article  Google Scholar 

  8. 8.

    Schiestl C, Neuhaus K, Zoller S, Subotic U, Forster-Kuebler I, Michels R, Balmer C, Weibel L (2011) Efficacy and safety of propranolol as first-line treatment for infantile hemangiomas. Eur J Pediatr 170(4):493–501

    PubMed  Article  CAS  Google Scholar 

  9. 9.

    Storch CH, Hoeger PH (2010) Propranolol for infantile haemangiomas: insights into the molecular mechanisms of action. Br J Dermatol 163(2):269–274

    PubMed  Article  CAS  Google Scholar 

  10. 10.

    Yeh I, Bruckner AL, Sanchez R, Jeng MR, Newell BD, Frieden IJ (2011) Diffuse infantile hepatic hemangiomas: a report of four cases successfully managed with medical therapy. Pediatr Dermatol 28(3):267–275

    PubMed  Article  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Aylin Tekes.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Bosemani, T., Puttgen, K.B., Huisman, T.A.G.M. et al. Multifocal infantile hepatic hemangiomas—imaging strategy and response to treatment after propranolol and steroids including review of the literature. Eur J Pediatr 171, 1023–1028 (2012).

Download citation


  • Infantile hepatic hemangioma
  • Propranolol
  • Steroid
  • Imaging strategy
  • MRI
  • US