History of the infantile hepatic hemangioma: From imaging to generating a differential diagnosis

Table 1 Description of the clinical, radiological, histological findings of the different subtypes of infantile hepatic hemangiomas and recommended treatment for the three different subgroups of infantile hepatic hemangiomas

IHH	Focal	Multifocal	Diffuse
Onset	Prenatal development	Postnatal (few weeks after birth)	Postnatal (few weeks after birth)
Association with cutaneous IH	Rarely	Frequently	Frequently
MRI	Solitary tumor; robust enhancement; often with Ca2+ and central cystic change	Hypointense to liver on T1, hyperintense on T2. Rapid enhancement. May have central flow voids on T2 spin echo sequence	Near-total replacement of the hepatic parenchyma with many lesions
CT	Rapid enhancement. Often with Ca2+ and central cystic changes	Homogenously; uniform or centripetal	Innumerable centripetally but rapidly enhancing lesions
Glut-1 staining	Negative	Positive	Positive
Comorbidities	Possible anemia and relatively mild thrombocytopenia; AV shunting; High-output cardiac state	High-flow shunting resulting in high-output; Cardiac failure	High-output cardiac failure; Abdominal compartment syndrome; Severe hypothyroidism
Treatment	Observation; embolization for problematic shunting	Observation; propranolol/embolization for problematic shunting, possibly propranolol; hypothyroidism	Propranolol, thyroid hormone replacement, embolization in the cases of severe arteriovenous shunting (rare in diffuse IHHs), transplantation evaluation for the most extreme cases

IHH: Infantile hepatic hemangioma; CT: Computed tomography; MRI: Magnetic resonance imaging.