Giant hepatic hemangioma in the fetus: case reports and updated review of the literature

Abstract

Objectives

To describe three cases of giant fetal hepatic hemangioma detected by prenatal ultrasound in the third trimester of pregnancy and further confirmed by fetal magnetic resonance imaging (MRI). An updated review of the literature was also carried out.

Results

In one case, there was an unexpected intrauterine demise at 35 weeks. The other two women delivered liveborn infants at term. The first of these two neonates had a stormy neonatal course and underwent endovascular embolization with limited clinical success. The infant presented multiple medical complications and was discharged home at five months of age. The second infant had an uneventful postnatal course. Subsequent follow-up scans showed progressive shrinkage of the lesion with no associated complications. A review of the English literature revealed a total of 42 cases prenatally diagnosed by ultrasound. The most relevant clinical and ultrasound findings are presented and the diverse perinatal outcomes related to this condition are discussed.

Conclusions

Fetal hepatic hemangiomas are exceedingly rare vascular tumors; however, they can be associated with several life-threatening conditions. They are usually detected by ultrasound, either incidentally or in the context of nonimmune hydrops secondary to high-output cardiac failure. Our review documents the increasing role of fetal MRI in the prenatal diagnosis and management of these cases. However, the improvement in prenatal diagnostic imaging techniques has not been associated with a better perinatal prognosis in the reported cases.

Keywords:

• Fetal hemangioma
• fetal tumor
• fetal ultrasound
• hepatic hemangioma
• magnetic resonance imaging
• prenatal diagnosis

Ethical statement

The ultrasound protocols and interventional procedures performed in our patients were approved by the corresponding Institutional Review Boards. Fetal ultrasound examination during the third trimester and the corresponding clinical follow-up in cases when abnormal findings were detected prenatally were performed as part of our standard clinical care. All women participating in this study voluntarily attended and consented to the ultrasound examination. Due to the de-identified nature of this research, permission from the Institutional Review Board was waived.

Acknowledgements

The medical and paramedical personnel from the Pediatric Departments, Regional Hospital, Rancagua; “Luis Calvo Mackenna” Hospital, Santiago; and Clinica Alemana, Santiago, are acknowledged for their participation in the postnatal care of cases 2 and 3 described in this report.

Disclosure statement

No potential conflict of interest was reported by the authors with respect to the research, authorship, and/or publication of this article.

Data availability statement

All the clinical, ultrasonographic, and radiological information pertinent to the patients described in this research are fully available in the description of the cases in the case reports section of the article.

Additional information

Funding

This work was supported by an unrestricted research grant from the Sociedad Profesional de Medicina Fetal “Fetalmed” Ltda, Chile.