Dr. Alan Greene answers the questions, How dangerous is a hemangioma? Does it need treatment?



My 4-month-old has a small hemangioma under her jaw under the skin. At her last well-child visit, the pediatrician was feeling her abdomen and said that she can usually feel the edge of the liver and she could not, so she ordered an ultrasound to see if she has another hemangioma in her liver. If she has one, what is the course of treatment? Is surgery needed? How dangerous is this?


I have a hemangioma in my liver. Hemangiomas are extra collections of blood vessels and most of the time this condition does not cause problems. Often they get smaller and disappear during the first few years of life.

Large liver hemangiomas can sometimes cause problems with blood flow, sometimes allowing direct connections between arteries and veins, bypassing the normal circulation. If this is the case you can sometimes hear it with a stethoscope over the liver; kids many not grow as well and the liver is usually enlarged.

If the hemangioma is big enough to cause problems and treatment is needed sooner than waiting for it to get better on its own, then there are several options, including medicines such as steroids or interferon, or surgery. But probably the most common treatment (again, if treatment is even needed -- most disappear entirely on their own) is something called catheter embolization where something like a long IV is put in and then a balloon, a tiny coil, or even a drop of super glue is used to close the blood vessels. The biggest problem with hemangiomas is that if there is a lot of blood flowing through, this makes the heart work much harder to keep up. If not treated, the largest ones could lead to heart failure. Treatment, however, is very effective. Often, even if treatment is needed, the hemangioma isn't treated directly but medicines are given to help the heart with the extra load while waiting for the hemangioma to go away.

Most of these are found at an early age. Mine was found by accident on a different ultrasound and has never caused any problems and never should. It is just like a little birthmark inside. Many people have them and no one ever had reason to discover it. Before ultrasounds and MRIs, not that long ago, we only knew about the very worst ones. Now they show up as incidental findings all the time.

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