Liver Hemangioma

Overview

What is a liver hemangioma?

A liver hemangioma (hepatic hemangioma) is a noncancerous tumor in your liver. It’s made up of clumped, malformed blood vessels that are fed by the hepatic artery. Hemangioma tumors can occur in various organs, including the brain, where they can sometimes cause problems. In the liver, though, they rarely do. They don’t turn to cancer and only cause symptoms if they grow especially large.

What does a hemangioma in the liver mean?

Scientists aren’t sure why liver hemangiomas occur. If you get one, you can consider it an anomaly. Some think it might be a birth defect. It doesn’t indicate anything is wrong with your liver, and it generally won’t cause problems for your liver. Most people just get one hepatic hemangioma. It won't spread and rarely grows in size. In most cases, you can leave it alone and go on with your life.

Should I be worried about liver hemangioma?

Liver hemangiomas in adults and children are generally nothing to worry about. Only 10% of them ever grow at all, and your tumor would have to grow a lot before you would feel it compressing your stomach or vessels. Your healthcare provider will keep an eye on it and intervene before that happens. Infantile hepatic hemangioma (IHH), which affects babies, is a different entity and can follow a different course.

How common are liver hemangiomas?

Liver hemangiomas are the most common type of benign liver lesions. They occur in approximately 5% of the population. They most commonly appear in middle age (70%) and in people assigned female at birth (80%). When they occur in infancy, they normally shrink over time and disappear by adulthood.

Symptoms and Causes

What are the symptoms of liver hemangioma?

Most liver hemangiomas are small and don’t cause symptoms. The average size is about 3 centimeters (cm). Tumors that are 10 cm or more are considered “giant hemangiomas." These are the most likely to cause symptoms, due to swelling or compression of your stomach. The most common symptoms are:

What other complications could a liver hemangioma cause?

Rare complications include:

  • Compression of your blood vessels or bile ducts, causing edema, thrombosis or jaundice.
  • Bleeding from the malformed blood vessels in the tumor into your abdominal cavity.
  • Degeneration inside the tumor, such as blood clotting, scarring or calcium deposits.
  • Direct trauma to the liver or severe strain can very rarely cause rupture of the tumor and internal bleeding (hemorrhage). This would be an emergency.

What do liver hemangiomas look like?

To the naked eye, they look like flat lesions with well-defined borders and a dark, red-blue color. They may be surrounded by a thin tissue capsule. Under a microscope, you can see they are made up of cavernous vascular compartments filled with blood. This is why they are sometimes called cavernous hemangiomas.

What causes liver hemangiomas?

We don't know what causes them. Some suspect they may be congenital or even genetically inherited. There also appears to be some connection between liver hemangiomas and estrogen. They occur more often and grow faster in people assigned female at birth, especially when more estrogen is present, such as during female puberty, pregnancy and hormone replacement therapy.

Is there any connection between hemangioma and alcohol?

Alcohol use does not appear to be a risk factor for liver hemangiomas. It’s more associated with malignant (cancerous) liver lesions. Alcohol does cause problems for your liver, but not hemangiomas.

Diagnosis and Tests

How is a liver hemangioma diagnosed?

Since most don’t cause symptoms, most are diagnosed incidentally. They may appear on an imaging test taken for another reason. Imaging tests that can identify a liver hemangioma include:

  • Contrast-enhanced ultrasound. High-frequency sound waves are sent through body tissues and the echoes are recorded and transformed into video or photos.
  • Computed tomography (CT) scan. X-rays and computers produce images of a cross-section of your body.
  • Magnetic resonance imaging (MRI). A large magnet, radio waves and a computer produce images.
  • X-ray contrast to look at the blood vessels in your body.
  • A nuclear scan that uses a radioactive trace material called Technetium-99m to form an image of the hemangioma.

How can they tell if I have a liver hemangioma vs. cancer?

Most of the time, imaging tests are enough to tell the two apart. But if your hemangioma doesn’t have the typical features, they may need to investigate further to distinguish it from liver cancer. For example, a cancerous tumor of the liver (hepatocellular carcinoma) would typically change its appearance over time, while a hemangioma would remain stable. A metastatic cancer that spread to your liver from somewhere else would also be found elsewhere in your body.

Management and Treatment

Do liver hemangiomas need to be removed?

Not unless they cause you problems. If your hemangioma appears to be growing, your healthcare provider may suggest interventions to stop it before it becomes a problem. They can cut off its blood supply by blocking or tying off the hepatic artery (arterial embolization). This can slow or even reverse its growth. If it continues growing, or if it causes any symptoms or complications, they can remove it in surgery.

How are liver hemangiomas usually treated?

In most cases, your healthcare provider will simply keep your tumor under observation. They may want to take an imaging scan once or twice a year to keep track of any changes. Most hemangiomas won’t ever change or grow. If they do, it's usually slow — about 2mm a year.

Should I be worried about liver hemangioma complications during pregnancy?

Estrogen levels do increase during pregnancy, which can cause your hemangioma to grow faster if it grows at all. It still isn’t likely to grow a lot in nine months. However, depending on how big it is already, your healthcare provider may want to treat it preventatively to stop it from growing. A larger hemangioma, combined with severe strain during labor, could slightly raise the risk of rupture.

Prevention

Are liver hemangiomas preventable?

Since we don’t know what causes them, we don’t know how to prevent them. However, high estrogen may be a factor. If you have a liver hemangioma, you may be able to slow or prevent its growth by stopping or avoiding hormone replacement therapy

Outlook / Prognosis

What is the prognosis with liver hemangioma?

In general, the prognosis is excellent. Most liver hemangiomas won’t cause any trouble, and when they do, surgery is a simple solution.

Living With

Does my diet affect my liver hemangioma?

No, but your diet does affect the general health of your liver. If you want to reduce overall stress on your liver, a healthy diet can make a difference. Reducing sugar and fat in your diet can help prevent or reduce fat storage in your liver.

When should I seek medical attention for my hemangioma?

Seek medical attention for any uncomfortable symptoms, including pain and problems with your digestive system. In most cases, these symptoms won’t be related to your liver hemangioma, but your healthcare provider can help you sort out the cause.

A note from Cleveland Clinic

Nobody likes to find out they have a tumor, but liver hemangiomas are common and benign. If you have one, it will probably never bother you. It won’t turn into another type of tumor, as some benign lesions can. It usually won’t grow or change at all. You can feel at ease leaving it alone and letting your healthcare provider keep an eye on it. If you have a large or symptomatic liver hemangioma, your healthcare provider can offer ways of treating it. Surgery, if necessary, will remove the tumor.

Last reviewed by a Cleveland Clinic medical professional on 05/22/2022.

References

  • MedlinePlus. Hepatic hemangioma. (https://medlineplus.gov/ency/article/000243.htm) Accessed 5/22/2022.
  • Medscape. Hepatic Hemangiomas. (https://emedicine.medscape.com/article/177106-overview) Accessed 5/22/2022.
  • Merk Manual Consumer Version. Hemangiomas of the Liver. (https://www.merckmanuals.com/home/liver-and-gallbladder-disorders/tumors-of-the-liver/hemangiomas-of-the-liver) Accessed 5/22/2022.
  • Ribeiro MA Jr, Papaiordanou F, Gonçalves JM, Chaib E. Spontaneous rupture of hepatic hemangiomas: A review of the literature. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3010512/) World J Hepatol. 2010;2(12):428-433. Accessed 5/22/2022.

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