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World J Clin Pediatr. Aug 8, 2016; 5(3): 273-280
Published online Aug 8, 2016. doi: 10.5409/wjcp.v5.i3.273
History of the infantile hepatic hemangioma: From imaging to generating a differential diagnosis
Maria Gnarra, Gerald Behr, Alison Kitajewski, June K Wu, Sudha A Anupindi, Carrie J Shawber, Nick Zavras, Dimitrios Schizas, Chris Salakos, Konstantinos P Economopoulos
Maria Gnarra, Vascular Biology Program, Department of Surgery, Boston Children’s Hospital and Harvard Medical School, Boston, MA 02115, United States
Gerald Behr, Department of Radiology, Columbia University Medical Center, New York, NY 10020, United States
Alison Kitajewski, June K Wu, Carrie J Shawber, Department of Surgery, Columbia University Medical Center, New York, NY 10020, United States
Sudha A Anupindi, Department of Radiology, the Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19082, United States
Carrie J Shawber, Department of OB/GYN, Columbia University Medical Center, New York, NY 10020, United States
Nick Zavras, Dimitrios Schizas, Chris Salakos, Department of Pediatric Surgical, “ATTIKO” General University Hospital, 12462 Haidari, Greece
Dimitrios Schizas, Chris Salakos, Konstantinos P Economopoulos, Society of Junior Doctors, Surgery Working Group, 15123 Maroussi, Greece
Konstantinos P Economopoulos, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States
Author contributions: All authors contribute to the final manuscript.
Conflict-of-interest statement: All the authors declare that they have no competing interests.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Konstantinos P Economopoulos, MD, PhD, Postdoctoral Research Fellow, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 101 Merrimac street, Boston, MA 02114, United States. keconomopoulos@mgh.harvard.edu
Telephone: +1-617-5104641
Received: January 19, 2016
Peer-review started: January 19, 2016
First decision: March 24, 2016
Revised: April 6, 2016
Accepted: June 1, 2016
Article in press: June 3, 2016
Published online: August 8, 2016
Abstract

We aim to provide an up-to-date summary of infantile hepatic hemangioma (IHH) and its misnomers and to dialectically present the differential diagnosis of these rare entities of the liver. Eligible peer-reviewed articles on hepatic infantile hemangiomas, published between 2000 and 2015, were reviewed for this study. IHH is the most common hepatic vascular tumor in children. Once a liver mass is identified in an infant, the differential diagnosis ranges from vascular malformations to benign and malignant tumors including mesenchymal hamartoma, hepatoblastoma, metastatic neuroblastoma, so careful physical examination, imaging studies, and, if indicated, tumor markers and biopsy, are of pivotal importance to ascertain the correct diagnosis. Despite the benign nature of IHHs, some of these lesions may demand medical and/or surgical intervention, especially for multiple and diffuse IHH. Complications can include hepatomegaly, hypothyroidism and cardiac failure. Therefore, a close follow-up is required until complete involution of the lesions. We propose an algorithm to guide the physicians towards the proper management of hepatic lesions.

Keywords: Hepatic hemangiomas, Infant, Children, Vascular tumors

Core tip: Differential diagnosis of pediatric liver lesions ranges from vascular malformations to benign and malignant tumors. Infantile hepatic hemangioma (IHH) is the most common, benign, hepatic vascular tumor in infants. They are sub-classified in focal, multiple and diffuse lesions, based on degree of unaffected liver parenchyma. Despite the benign nature of IHHs, multiple and diffuse lesions can present with life-threatening complications including severe hypothyroidism and cardiac failure, requiring prompt medical intervention. Therefore, a proper diagnosis is of pivotal importance. Including severe hypothyroidism and cardiac failure, requiring prompt medical intervention, therefore, a proper diagnosis is of pivotal importance.