Pudil J, Martínek J, Belsan T, Ryska M
Chirurgická klinika 2. LF UK a UVN Praha.
Rozhl Chir. 2006 Jul;85(7):354-6.
Haemangioma is a benign mesenchymal tumor growing from the endothehum of blood vessels. Most hepatic haemangiomas are asymptomatic while symptomatic haemangioma are usually manifested by non-specific pain dyspeptic syndrome, quite rarely also by hemorrhage, or icterus Symptomatic haemangiomas or large haemangiomas with fast growth, are indicated for surgical treatment.
The authors present a 50-year-old patient with chronic dyspeptic condition and pressure pain in the epigastria. USG, CT, MR, CT angiography and EUS have all shown two lesiones (haemangioma of the left hepatic lobe, a tumor in the left subphrenic area of uncertain origin). We proposed an operational solution, and, surprisingly, the finding was a single haemangioma (2 parts-- intra- and extraparenchymatous--connected by a vascular bridge). We then performed left lobectomy.
In the diagnosis of haemangioma, MR is a method of choice with high specificity and sensitivity. Why did not it yield the correct diagnosis? The structure, the signal and the type of postcontrast enhancement of the second lesion corresponded to a haemangioma, but the extraparenchymatous location and also the considerable remoteness from the liver invalidated this possibility before operation. Regarding to the differential diagnostics of the lesiones in the subphrenic area, which according to the imaging techniques are not related to the hepatic parenchyma, it is advisable to consider the possibility of the incidence of pedunculated hepatic haemangioma.
血管瘤是一种由血管内皮生长而来的良性间叶组织肿瘤。大多数肝血管瘤无症状，而有症状的血管瘤通常表现为非特异性疼痛、消化不良综合征，很少也表现为出血或黄疸。有症状的血管瘤或生长迅速的大血管瘤，建议手术治疗。
作者介绍了一名50岁患有慢性消化不良和上腹部压痛的患者。超声、CT、磁共振成像、CT血管造影和超声内镜检查均显示有两个病变（左肝叶血管瘤，左膈下区域一个来源不明的肿瘤）。我们提出了手术方案，令人惊讶的是，发现是一个单一的血管瘤（由血管桥相连的两部分——实质内和实质外）。然后我们进行了左叶切除术。
在血管瘤的诊断中，磁共振成像是一种具有高特异性和敏感性的首选方法。为什么它没有得出正确的诊断呢？第二个病变的结构、信号和增强后造影剂类型与血管瘤相符，但实质外位置以及与肝脏的相当距离在手术前排除了这种可能性。关于膈下区域病变的鉴别诊断，根据成像技术这些病变与肝实质无关，建议考虑带蒂肝血管瘤发生的可能性。
