[Personal experience in embolization of liver hemangiomas].

INTRODUCTION

Cavernous haemangioma is the most often found benign liver tumour. Its size usually does not change, although there are cases in which it grows. Large haemangiomas can cause hepatomegaly, pain in the right subcostal area, and spontaneous ruptures. By modern diagnostic procedures they are detected more often and therefore gained more diagnostic importance. Cavernous haemangiomas, especially giant ones, can be treated surgically (enucleation or resection of a part of the liver), by embolization or by other procedures. The aim of the study was to determine the important role of embolization in the treatment of symptomatic haemangiomas with risk of rupture.

MATERIAL AND METHODS

Over a period of 5 years, at the Department of Gastroenterology and Hepatology, haemangioma was discovered in 35 of 178 patients with focal liver lesions. Eighteen (51%) patients were males and 17 (49%) females. In 21 (60%) patients, the size of the tumour was 2-4 cm, in 10 (29%) 5-10 cm, and in 4 more than 10 cm. Ultrasonography, computerized tomography, celiacography, scintigraphy with blood pool and ultrasound guided liver biopsy were used to diagnose haemangiomas. Polyvinyl-alcohol (Ivalon) was used for embolization. Through femoral catheter truncus coeliacus was reached, a. hepatica was catheterized, contrast was injected, and then microembolization of peripheral branches was performed. In 10 patients, because of the size of haemangioma, symptoms or localization, and a high risk of bleeding, embolization was performed. Biochumoral parameters were analyzed on the first, the second and the seventh day after the intervention. Within the period of five years, control ultrasound examinations were performed in all patients, and results were compared. In 9 patients control liver scintigraphy with blood pool was carried out.

RESULTS

Embolization was performed with polyvinyl-alcohol. During angiography which followed, avascular zones were seen. There was no statistically significant difference between biochumoral parameters before and after embolization. Five years after the embolization, a reduced size of haemangioma was found in 8 patients. The echosonographic appearance of the tumour was changed in almost all patients. All clinical symptoms disappeared. There was no bleeding. In 8 of 9 patients liver scintigraphy with blood pool was performed, and there were no "warm fields."

DISCUSSION

Due to modern diagnostic procedures, haemangiomas are now more often detected. However, ultrasonography is not always specific in discovering haemangiomas. Liver scintigraphy does not always reveal the typical shape of these tumours. Every procedure has its advantages and disadvantages. Once haemangioma is detected, it is the question how to treat it. Experience of most hepatologists suggests that interventions should be performed only in case of symptomatic haemangiomas, progressively growing haemangiomas, and in case of the high risk of bleeding. Embolization of the hepatic artery, previously used only as the first part of surgical procedures is now used as the only procedure in the treatment of these tumours. Some authors reported pain and fever after this intervention, which were also noticed in our patients. The reported agranulomatous arteritis with eosinophilic infiltration was not found in our patients. There were no significant changes in biochumoral analysis; this finding confirmed that there was no necrosis around embolized haemangioma. On the basis of the follow-up of our patients we came to the conclusion that embolization of haemangioma, performed by an experienced radiologist, is a very useful procedure in the therapy of symptomatic haemangiomas and haemangiomas with a high risk of bleeding.