SYMPTOMATIC LIVER HEMANGIOMA WITH INTRA-TUMOR HEMORRHAGE TREATED BY ANGIOGRAPHY AND EMBOLIZATION DURING PREGNANCY

Background: Cavernous hemangiomas are the most common benign tumors of the liver and are found in about 2% of autopsy patients. The vast maj ority are small (less than 4 cm) and asymptomatic, but there have been a few reported cases of these lesions leading to severe pain and even spontaneous fatal hemorrhage. Estrogen may cause the growth of liver hemangiomas, but there is a paucity of information concerning the effe ct of pregnancy upon these lesions. Case: A patient presented at 18 we eks' gestation with the acute onset of vomiting and epigastric pain. A right upper-quadrant ultrasound scan found a 9-cm hypodense lesion wi thin the liver, and magnetic resonance imaging (MRI) suggested a heman gioma. The lesion was believed to be inoperable, and selective cathete rization of the common hepatic artery was performed. An angiogram demo nstrated a round vascular mass 12 cm in diameter occupying much of the left side of the liver, with the vascular supply from the middle hepa tic artery and to a lesser extent from the left hepatic artery. Emboli zation was performed, and a post-embolization image demonstrated satis factory occlusion of the vessels treated. The patient's epigastric pai n resolved after the procedure. The lesion was observed with monthly u ltrasound and regressed to about 50% of its original size. The patient was scheduled for an elective primary cesarean delivery at 39 weeks t o avoid possible rupture of the hepatic hemangioma during the second s tage of labor. Her cesarean and postpartum course were uncomplicated. Conclusion: A symptomatic liver hemangioma with intra-tumor hemorrhage can be successfully treated with embolization during pregnancy. Becau se of the paucity of reported cases, it is uncertain whether vaginal b irth is contraindicated in these patients.