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Wang L, Song D, Wu C, Li J, Yin J, Guo L. Infantile hepatic hemangioendothelioma associated with pulmonary artery hypertension and cardiac insufficiency successfully treated with transcatheter arterial embolization and propranolol: A case report. Medicine (Baltimore) 2020; 99:e20728. [PMID: 32541524 PMCID: PMC7302649 DOI: 10.1097/md.0000000000020728] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Infantile hepatic hemangioendothelioma is a type of benign hepatic tumor that occurs in infancy. Many hepatic tumors are diagnosed when screening is done for multiple cutaneous hemangiomas. Hepatic tumors are small multifocal lesions and are mostly asymptomatic. There have been many case reports of asymptomatic infantile hepatic hemangioendothelioma, but few of these have pointed out that hepatic hemangiomas can sometimes be life-threatening due to fatal hepatomegaly complications such as pulmonary artery hypertension or even congestive heart failure. At present, there are no standard protocols for treating infantile hepatic hemangioendothelioma, though most clinicians agree that treatment is unnecessary for multiple small hepatic hemangiomas in asymptomatic patients. Little is known about treatment for cases with life-threatening complications induced by infantile hepatic hemangioendothelioma as there are so few reported cases. Here, we report a special case with hepatomegaly, pulmonary artery hypertension, and cardiac insufficiency induced by infantile hepatic hemangioendothelioma. PATIENT CONCERNS We present a case with hepatomegaly, pulmonary artery hypertension, and cardiac insufficiency caused by infantile hepatic hemangioendothelioma. DIAGNOSIS Infantile hepatic hemangioendothelioma was diagnosed. INTERVENTIONS The patient underwent transcatheter arterial embolization and was given propranolol. OUTCOMES The patient responded well to treatment with transcatheter arterial embolization and propranolol. The patient gained weight steadily, liver volume, and mass size have decreased considerably, echocardiography showed normal pulmonary artery pressure and ejection fraction, and we discovered no serious complications after 1 year of follow-up. CONCLUSION Transcatheter arterial embolization combined with propranolol is an effective treatment for life-threatening infantile hepatic hemangioendothelioma.
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Affiliation(s)
- Liang Wang
- Department of Vascular Anomalies and Interventional Radiology, Ji’nan Children's Hospital, Jinan
| | - Dan Song
- Department of Vascular Anomalies and Interventional Radiology, Ji’nan Children's Hospital, Jinan
| | - Changhua Wu
- Department of Vascular Anomalies and Interventional Radiology, Ji’nan Children's Hospital, Jinan
| | - Jing Li
- Department of Vascular Anomalies and Interventional Radiology, Ji’nan Children's Hospital, Jinan
| | - Jie Yin
- Department of Interventional Radiology, Beijing Children's Hospital of Capital Medical University, Beijing, China
| | - Lei Guo
- Department of Vascular Anomalies and Interventional Radiology, Ji’nan Children's Hospital, Jinan
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Zhang XT, Ren WD, Song G, Xiao YJ, Sun FF, Wang N. Infantile hepatic hemangiomas associated with high-output cardiac failure and pulmonary hypertension. BMC Cardiovasc Disord 2019; 19:216. [PMID: 31601179 PMCID: PMC6788120 DOI: 10.1186/s12872-019-1200-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 09/23/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Infantile hepatic hemangioma (IHH) is a rare endothelial cell neoplasm, which may be concurrent with severe complications and result in poor outcomes. Moreover, the coexistence of IHH and congenial heart disease is even rarer. CASE PRESENTATION We present a 10-day-old male born with IHH associated with patent ductus arteriosus (PDA), atrial septal defect (ASD) and pulmonary hypertension. Moreover, we reviewed a series of studies of IHH-associated high-output cardiac failure between 1974 and 2018, and summarized the treatment outcomes. CONCLUSIONS Infantile hepatic hemangioma (IHH) has been known to induce high-output heart failure. There is no literature to summarize the severity of its impact on heart, which can lead to a high mortality rate. When IHH is detected by ultrasound, the heart should be evaluated to facilitate treatment. The outcomes of IHH associated with heart failure are good.
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Affiliation(s)
- Xin-Tong Zhang
- Department of Ultrasound, Shengjing Hospital of China Medical University, sanhao street 36#, Shenyang, 110004, CN, China
| | - Wei-Dong Ren
- Department of Ultrasound, Shengjing Hospital of China Medical University, sanhao street 36#, Shenyang, 110004, CN, China.
| | - Guang Song
- Department of Ultrasound, Shengjing Hospital of China Medical University, sanhao street 36#, Shenyang, 110004, CN, China
| | - Yang-Jie Xiao
- Department of Ultrasound, Shengjing Hospital of China Medical University, sanhao street 36#, Shenyang, 110004, CN, China
| | - Fei-Fei Sun
- Department of Ultrasound, Shengjing Hospital of China Medical University, sanhao street 36#, Shenyang, 110004, CN, China
| | - Nan Wang
- Department of Ultrasound, Shengjing Hospital of China Medical University, sanhao street 36#, Shenyang, 110004, CN, China
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Maaloul I, Aloulou H, Hentati Y, Kamoun T, Mnif Z, Hachicha M. Infantile hepatic hemangioendothelioma successfully treated by low dose of propranolol. Presse Med 2017; 46:454-456. [PMID: 28318668 DOI: 10.1016/j.lpm.2017.01.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 12/06/2016] [Accepted: 01/24/2017] [Indexed: 11/27/2022] Open
Affiliation(s)
- Ines Maaloul
- Hedi Chaker Hospital, Pediatric Department, Sfax, Tunisia.
| | - Hajer Aloulou
- Hedi Chaker Hospital, Pediatric Department, Sfax, Tunisia
| | - Yosr Hentati
- Hedi Chaker Hospital, Department of Radiology, Sfax, Tunisia
| | | | - Zeineb Mnif
- Hedi Chaker Hospital, Department of Radiology, Sfax, Tunisia
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Gil L, Yoo KY, Jung HJ, Park JE. Neonatal Hepatic Hemangioendothelioma: A Single Institute Experience. CLINICAL PEDIATRIC HEMATOLOGY-ONCOLOGY 2016. [DOI: 10.15264/cpho.2016.23.1.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Leehuck Gil
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea
| | | | - Hyun Joo Jung
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea
| | - Jun Eun Park
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea
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Wang T, Wang Y, Liang Y, Lu G. Infantile Hepatic Hemangioendothelioma Associated With Congestive Heart Failure: Two Case Reports With Different Outcomes. Medicine (Baltimore) 2015; 94:e2344. [PMID: 26717373 PMCID: PMC5291614 DOI: 10.1097/md.0000000000002344] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Infantile hepatic hemangioendothelioma (IHH) is rare which can regress spontaneously. Arteriovenous shunts within hemangiomas, however, may result in pulmonary artery hypertension (PAH) and congestive heart failure (CHF).The authors report 2 young infants suffering from multifocal IHH associated with CHF were both treated with glucocorticoid and transcatheter arterial embolization (TAE), but had different outcomes. The PAH decreased immediately and the symptoms of CHF were alleviated after TAE for both of them. For the Tibetan infant, the development was normal with tumor regression by follow-up. For the Han ethnic neonate, PAH increased again in the seventh day with progressive cardiovascular insufficiency. Ultrasound showed a persisting perfusion caused by collateralization around occluded main feeders. Furthermore, a pulmonary infection occurred and ventilation was performed. As a result, the infant died from multiorgan failure caused by CHF and infection.TAE is a treatment of reducing shunting for hemangiomas. Fistula recanalization in multifocal IHH, however, might be an important risk factor affecting the outcome of TAE. TAE should be further evaluated with special attention to anatomy of feeding and draining vessels, and cardiopulmonary conditions. In addition, the patients were susceptible to secondary pulmonary infection because of lung congestion. As well, the infant from the high altitude area showed better adaptability to hypoxia.
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Affiliation(s)
- Tao Wang
- From the Department of Pediatric Cardiology, Sichuan University West China Second University Hospital, Chengdu (TW, YW, GL); and Department of Pediatrics, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China (YL)
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Dasgupta MK, Das S, Patra C, Sarkar S. Symptomatic infantile hepatic hemangioendothelioma successfully treated with steroid. J Clin Neonatol 2014; 2:187-9. [PMID: 24404532 PMCID: PMC3883215 DOI: 10.4103/2249-4847.123099] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
A case of hepatic hemangioendothelioma presenting as congestive cardiac failure in a neonate is being reported which was managed successfully with oral prednisolone, resulting in improvement of symptoms and regression of tumor within 3 months.
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Affiliation(s)
- Malay Kumar Dasgupta
- Department of Paediatric Medicine, Radha Gobinda Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - Sabyasachi Das
- Department of Paediatric Medicine, Radha Gobinda Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - Chaitali Patra
- Department of Paediatric Medicine, Radha Gobinda Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - Shatanik Sarkar
- Department of Paediatric Medicine, Radha Gobinda Kar Medical College and Hospital, Kolkata, West Bengal, India
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Madan N, Arnon R, Arnon R. Evaluation of cardiac manifestations in pediatric liver transplant candidates. Pediatr Transplant 2012; 16:318-28. [PMID: 22420530 DOI: 10.1111/j.1399-3046.2012.01667.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Knowledge concerning the involvement of the cardiovascular system in children awaiting liver transplant is limited. Therefore, no guidelines have been established on evaluating this group of patients for cardiac disease. This review examines the diverse cardiovascular manifestations of liver disease in children. We also discuss the available testing and its applicability in screening for cardiac disease in this vulnerable population.
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Affiliation(s)
- Nitin Madan
- Division of Pediatric Cardiology, Department of Pediatrics, Mount Sinai School of Medicine, New York, NY 10029-6574, USA.
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Nam SH, Park JI, Kim DY, Kim SC, Kim IK. The Experience of Non-surgical Treatment for Infantile Hepatic Hemangioendothelioma. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2010. [DOI: 10.4174/jkss.2010.79.5.399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- So-Hyun Nam
- Department of Surgery, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Jeong-Ik Park
- Department of Surgery, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Dae-Yeon Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seong-Chul Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In-Koo Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Kretschmar O, Knirsch W, Bernet V. Interventional Treatment of a Symptomatic Neonatal Hepatic Cavernous Hemangioma Using the Amplatzer Vascular Plug. Cardiovasc Intervent Radiol 2006; 31:411-4. [PMID: 17031730 DOI: 10.1007/s00270-006-0123-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Percutaneous intervention is one treatment option for symptomatic hepatic hemangioma in infants. We report the case of a newborn (birth weight 4060 g) with a large hepatic cavernous hemangioma, which presented early with high cardiac output failure due to arteriovenous shunting and signs of incipient Kasabach-Merritt syndrome. We performed a successful superselective transcatheter coil embolization of three feeding arteries on the seventh day of life. Because of remaining diffuse very small arteries causing a relevant residual shunt, additional occlusion of the three main draining veins was necessary with three Amplatzer vascular plugs. Cardiac failure resolved immediately. Without any additional therapy the large venous cavities disappeared within the following months. The tumor continues to regress in size 8 months after the intervention.
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Affiliation(s)
- Oliver Kretschmar
- Division of Pediatric Cardiology, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland.
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11
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Yeung CK, Chowdhary SK, Chan KW, Lee KH, Till H. Atypical Laparoscopic Resection of a Liver Tumor in a 4-Year-Old Girl. J Laparoendosc Adv Surg Tech A 2006; 16:325-7. [PMID: 16796452 DOI: 10.1089/lap.2006.16.325] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Despite the advances in minimally invasive surgery in children, considerable concern exists about employing such techniques in oncologic cases. We report our experience with a 4-year-old girl with a symptomatic tumor in the liver. Contrast-enhanced computed tomography revealed a 3 x 4 cm lesion, confined to segments II and III. Tumor markers were negative and true-cut needle biopsy did not rule out malignancy. We performed a diagnostic laparoscopy using four 5-mm ports. Since the tumor did not cause any alterations of the liver surface, a 5-mm flexible endoscopic ultrasound probe (5 MHz) was applied to reveal the extent of the tumor. Parenchymal dissection was performed with a radiofrequency probe, and the LigaSure device was used to seal larger vessels and bile ducts. The tumor was resected completely and removed in a specimen bag via the umbilical incision. Histology revealed fibrous nodular hyperplasia. The postoperative course was uneventful and the girl was discharged on postoperative day 5. We conclude that laparoscopic resection of confined liver lesions is feasible in children, employing standard principles of oncologic surgery and safety.
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Affiliation(s)
- Chung Kwong Yeung
- Division of Pediatric Surgery and Pediatric Urology, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China.
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12
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Warmann S, Bertram H, Kardorff R, Sasse M, Hausdorf G, Fuchs J. Interventional treatment of infantile hepatic hemangioendothelioma. J Pediatr Surg 2003; 38:1177-81. [PMID: 12891488 DOI: 10.1016/s0022-3468(03)00325-7] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND/PURPOSE Hemangioendothelioma is the most frequent liver tumor in infancy. Untreated symptomatic patients with heart failure have a high mortality rate. Symptomatic forms may request nonoperative treatment, because surgery is burdened with high risks in patients with heart failure. The authors report their experience with interventional coil occlusion of infantile hepatic hemangioendothelioma (IHE). METHODS Four patients (age range, 2 to 146 days; mean, 53 days) suffering from IHE associated with heart failure were treated by endovascular coil occlusion of arterial feeders. Catheter intervention was performed via an arterial (n = 2) or venous (n = 2) approach. RESULTS Signs of heart failure resolved within 2 to 8 days after occlusion in 3 patients. Tumor regression could be observed sonographically within 4 weeks postinterventionally. In 3 children, tumor size was reduced from a mean of 544 mL (65 to 1,350) to a mean of 4 mL (2 to 6); Mean systolic peak velocity in the hepatic artery was decreased from 170 cm/s (140 to 200) before occlusion to 45 cm/s (36 to 70) during follow-up. In the fourth patient, endovascular intervention could not control a rapidly progressing hemangioendotheliomatosis, and finally a liver transplantation had to be performed. CONCLUSIONS Interventional occlusion of feeding arteries in symptomatic IHE is a safe and effective alternative to early open surgery. The efficacy of endovascular intervention in multifocal tumors seems questionable.
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Affiliation(s)
- S Warmann
- Department of Pediatric Surgery, University of Tübingen, Tübingen, Germany
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Affiliation(s)
- M Reynolds
- Children's Memorial Hospital, Chicago, IL, USA
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14
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Abstract
Most tumors of the liver in children are malignant. Benign tumors occur most often in infants, are usually vascular, and seldom require surgery. Hepatoblastoma and hepatocellular carcinoma are the most common malignant tumors. Hepatoblastoma affects younger children and hepatocellular carcinoma affects older children and adolescents. Treatment consists of surgical resection before or after chemotherapy, and long-term survival is impossible without resection. Survival rate exceeds 80% in children with hepatoblastoma. Children with hepatocellular carcinoma and other more unusual malignant tumors do not do as well. Current treatment plans are described for both benign and malignant tumors of the liver.
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Affiliation(s)
- M Reynolds
- Northwestern University Medical School and the Department of Pediatric Surgery, Children's Memorial Hospital, Chicago, IL 60614, USA
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Le Luyer B, Duquenoy A, Poinsot J, Boulloche J, Gaussin G, Le Roux P. [Use of interferon in a case of hepatic hemangioma]. Arch Pediatr 2000; 7:1201-4. [PMID: 11109948 DOI: 10.1016/s0929-693x(00)00131-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
UNLABELLED Hepatic hemangioendothelioma can have a fatal outcome. After failure of classic therapies, and when surgery or arterial embolization are not possible, those benign tumours may benefit from interferon alpha treatment. CASE REPORT We report a case of a 14-month-old infant who presented with hepatic hemangiomatosis and cardiac failure. The disease can neither be controlled by steroids nor by radiotherapy associated with digitalo-diuretic treatment. Due to the important vascular volume of the tumour, neither surgical care nor arterial embolization were possible. Thus this infant was treated for ten months by interferon alpha. The evolution was favourable: cardiac failure, calcifications and volume of the angiomatosis were regressive. CONCLUSION Interferon alpha treatment helps to control cardiac failure and the course of hepatic hemangioma in childhood.
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Affiliation(s)
- B Le Luyer
- Département de pédiatrie, hôpital de l'Enfant, Le Havre, France
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Affiliation(s)
- R Kaye
- Department of Radiology, Children's Hospital of Pittsburgh, Pennsylvania, USA
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Hosono S, Ohno T, Kimoto H, Nagoshi R, Shimizu M, Nozawa M, Fuyama Y, Kaneda T, Moritani T, Aihara T. Successful transcutaneous arterial embolization of a giant hemangioma associated with high-output cardiac failure and Kasabach-Merritt syndrome in a neonate: a case report. J Perinat Med 2000; 27:399-403. [PMID: 10642962 DOI: 10.1515/jpm.1999.055] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We describe the case of a patient with a neonatal giant cutaneous hemangioma with high-output cardiac failure and Kasabach-Merritt syndrome and successfully treated with transcutaneous arterial embolization aimed at controlling severe congestive heart failure and consumption coagulopathy. A patient was admitted to the neonatal care unit on the first day of age because of a large hemangioma on his right lateral chest wall and respiratory distress, associated with cardiac failure resulting from arteriovenous shunting. On the second day of age the platelet count decreased to 5.7 x 10(4)/microliter and fibrinogen level was 85 mg/dl. The values of prothrombin time and activated partial thromboplastin time were prolonged. Intravenous predonisone therapy was started immediately, but bleeding tendency was getting worse and the evidence of congestive heart failure persisted. On the third day the patient then underwent embolization of feeding arteries with microcoils. The cardiac failure and thrombocytopenic coagulopathy had improved significantly without complications. We conclude that transcutaneous arterial embolization is an effective and safe treatment in this neonate and should be considered for the treatment of control high-output cardiac failure and coagulopathy in infants with hemangioma and Kasabach-Merritt syndrome.
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Affiliation(s)
- S Hosono
- Division of Neonatology, Saitama Children's Medical Center, Japan.
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Abstract
An infant or child who presents with a large intrahepatic mass will most likely have a malignant tumor. In children, benign tumors constitute only 30% of liver tumors and most are vascular in origin. Treatment of benign vascular tumors is conservative and seldom surgical. Hepatoblastoma is the most common malignant tumor followed by hepatocellular carcinoma. Treatment of malignant tumors is based on a combination of surgery and chemotherapy. Children with hepatic malignancies that can be resected have an excellent prognosis. Other rare benign and malignant tumors of the liver do occur and surgery plays a critical role in management.
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Affiliation(s)
- M Reynolds
- Northwestern University Medical School and Children's Memorial Hospital, Chicago, Illinois.
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Daller JA, Bueno J, Gutierrez J, Dvorchik I, Towbin RB, Dickman PS, Mazariegos G, Reyes J. Hepatic hemangioendothelioma: clinical experience and management strategy. J Pediatr Surg 1999; 34:98-105; discussion 105-6. [PMID: 10022152 DOI: 10.1016/s0022-3468(99)90237-3] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE This study sought to define management strategies based on clinical experience in treating infantile hepatic hemangioendothelioma. METHODS A retrospective analysis of patients with hemangioendothelioma presenting to a tertiary liver transplantation center between 1989 and 1997 was performed. RESULTS Thirteen patients (median age, 14 days) with hemangioendothelioma were identified. Congestive heart failure (P<.03) and abdominal mass (P<.081) were predictive of 5-month mortality rates. Ultrasonography and computerized axial tomography were the diagnostic modalities most commonly used. Treatment strategies consisted of medical management (steroids and alpha-interferon) and interventional modalities (hepatic artery ligation or embolization, resectional surgery, or orthotopic liver transplantation). Patients who underwent resectional surgery, with or without orthotopic liver transplantation, had a lower 5-month mortality rate (P<.02) and a greater 2-year survival rate (P<.003) than did those who underwent hepatic artery ligation or embolization. Early morbidity and mortality tended to be a consequence of the primary lesion, whereas late morbidity and mortality were reflective of the treatment modality used. CONCLUSIONS In cases of failed medical management, resectional therapy should be used when possible. If partial hepatectomy is not technically achievable, hepatic artery embolization should be used either as definitive therapy or as a temporizing measure until orthotopic liver transplantation is possible.
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Affiliation(s)
- J A Daller
- Thomas E. Starzl Transplant Institute, University of Pittsburgh and Children's Hospital of Pittsburgh Transplantation Surgery, PA 15213, USA
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