Management of massive hepatic hemangiomas in infants and children: a review of 13 cases.

From 1958 through 1978, 13 patients with diffused hepatic hemangioma were seen at Childrens Hospital of Los Angeles. Based on this experience and review of the literature, liver biopsy in these patients was found to be unnecessary and hazardous. Diagnosis can be made by dynamic and static hepatic scintigraphy and selective hepatic arteriography. Nonsurgical measures including treatment of congestive heart failure, corticosteroids, and radiotherapy are recommended for treatment of these patients. Surgery should be reserved only for emergencies, such as rupture of the tumor and hemorrhage, or for patients with severe congestive heart failure unresponsive to medical treatment. For the latter group of patients hepatic artery ligation is recommended. Hepatic artery embolization has recently been used, but experience with this new mode of therapy is limited.