Liver Hemangioma: Causes, Symptoms, and Treatment

What is a hemangioma of the liver? 

A hemangioma of the liver is a type of non-cancerous tumor made up of a malformed network of veins. Hemangiomas are rich in blood supply and can form cavities filled with blood. 

Most of the time, hemangiomas of the liver do not have symptoms and are usually found by accident when imaging is done for other reasons. 

Liver hemangiomas range from very small (1/16 of an inch) to “giant” (around 8 inches). Smaller hemangiomas generally do not cause any concerns or symptoms. However, large hemangiomas often require surgery or other treatment since they may start compressing against adjacent organs, such as the stomach, other blood vessels, or the bile ducts, leading to complications. 

What are the symptoms of a liver hemangioma?

As mentioned, a liver hemangioma typically does not have symptoms. They are usually only discovered when medical professionals carry out imaging for another purpose. When symptoms do occur, they are generally non-specific, meaning that they are not unique to the condition of liver hemangioma and could occur in many other health issues. 

Some symptoms include abdominal pain in the upper right area, poor appetite, feeling full early, nausea, and vomiting. These are all generic symptoms, and tests are required to make a definitive diagnosis. 

Complications of a liver hemangioma cause an additional set of symptoms based on the structure impacted by the hemangioma. For instance, complications may cause fever, jaundice, and bleeding if other blood vessels or the bile ducts are impacted. In extreme and rare cases, complications may cause symptoms of heart failure, liver damage, and other serious conditions.  

Liver hemangioma pictures

A cross-section through the abdomen showing a liver hemangioma (yellow arrow).¹

An ultrasound (left) and CT scan (right) of a liver hemangioma.²

What causes a liver hemangioma?

The underlying cause of a liver hemangioma isn’t fully understood. There may be certain genetic factors that increase susceptibility. 

There are several theories about the mechanism of a liver hemangioma. One view is that people with a liver hemangioma have issues with the process of blood vessel development. People with the condition may have too much of certain substances that cause blood vessel growth. 

There may be a hormonal component to this condition, as it disproportionately affects women, and hemangioma size increases more in those who are on hormonal oral contraceptive pills and those who have had hormone replacement therapy. Therefore, it is thought that estrogen might play a role in developing liver hemangiomas. 

How are liver hemangiomas diagnosed?

One or more imaging tests usually diagnose a liver hemangioma. Doctors typically use ultrasound, CT, or MRI scans to visualize the liver and look for signs of a hemangioma. More than one scan type may be required for more complex or unique cases. Doctors may also sometimes need to use contrast agents, dyes that help to visualize some liver structures better. 

Another technique, angiography, is sometimes used. This is a specific form of x-ray used to look at blood vessels. However, it can be invasive, so it is avoided in most straightforward cases that can be diagnosed with other imaging tests. Usually, there are no significant changes in blood tests or physical exams, meaning doctors rely on imaging to diagnose the condition.

Who is at risk of developing a liver hemangioma?

There are several risk factors for developing a liver hemangioma. Women are more likely to develop the condition, possibly due to the role of estrogen. In fact, for every man who has the condition, there are five women. You may also be at a higher risk if you have a family member with liver hemangioma.

The risk of complications from pre-existing liver hemangioma increases with the use of the oral contraceptive pill or hormone replacement therapy due to estrogen exposure. 

Certain medications can increase your risk of developing complications from liver hemangioma if used for long periods. For instance, long-term steroid use poses a risk. Some genetic factors may create risks, but more research is required in this area. 

Complications of a liver hemangioma

Most cases of a liver hemangioma are uncomplicated and don’t have symptoms. This means there is no real need for treatment, possibly only monitoring to ensure they are not increasing in size or compressing other structures. 

However, complications can arise, especially in larger or giant hemangiomas. Here is a breakdown of the different types of complications — inflammatory, mechanical, bleeding, and degenerative. 

Inflammatory

A liver hemangioma can result in acute (short-term) or chronic (long-term) inflammation. Acute inflammation usually results in a fever and goes away. However, chronic inflammation can cause further issues. For instance, patients may have chronic inflammation of the connective tissue around the liver, causing ongoing abdominal pain and discomfort.

Mechanical

In terms of mechanical complications, the hemangioma can rupture, which means break or burst. This can occur due to trauma or for no apparent reason. If ruptured, this will cause internal bleeding, which is an emergency that requires immediate medical help.

Another mechanical complication can occur if the hemangioma starts getting bigger and pushing against nearby organs or structures. For instance, if the hemangioma pushes on the stomach, it causes a loss of appetite or feeling full early. If the hemangioma presses on the bile ducts, it can cause jaundice or skin yellowing. This complication can also cause more serious effects like bowel obstruction that require surgery. 

Bleeding

When liver hemangiomas rupture, they can cause significant abdominal bleeding. This is a rare complication but very serious, with a high mortality rate. 

Degenerative

There are also degenerative complications of a liver hemangioma. This means that there are abnormal structures and buildups within the tumor. For instance, scar tissue, blood clots, or nodules may form, or there may be a buildup of calcium deposits. These factors can make the hemangioma more complex and predispose the patient to other complications, such as forms of liver disease. 

Treatment for a liver hemangioma

In most cases, a liver hemangioma does not have symptoms or require any treatment. Surgical treatments are used in some cases. For instance, surgery is indicated for those with a growing hemangioma or who experience pain even with medication. 

Restriction of blood flow to a hemangioma

Medical professionals can use surgical or non-surgical techniques to reduce the blood flow to the hemangioma and prevent growth. One approach is to tie and block off vessels contributing to the hemangioma surgically. This is called surgical transhepatic ligation. Additionally, angiographic embolization is a non-surgical technique. Here, substances are injected to reduce the tumor size and prevent growth. 

Surgical removal

In some cases, patients must undergo surgical resection or cutting of the hemangioma. Often, these surgeries can be done laparoscopically (less invasive). In some more severe cases, surgeons must remove parts of the liver. 

Liver transplantation

In extremely rare cases where patients have very large hemangiomas or tumors that extend to both sides of the liver, transplantation may be required. This is usually only the case if complications are severe or resection is not possible. 

Radiation therapy

Radiation therapy takes place over a few weeks and involves using radiation beams to target the hemangioma and cause the tumor to shrink. It is a relatively uncommonly used treatment. 

The lowdown

A liver hemangioma is a non-cancerous liver tumor made up of malformed blood vessels. A liver hemangioma usually does not cause symptoms and is generally found by accident when medical professionals carry out other investigations. 

When symptoms are present, they are usually non-specific and include abdominal pain, poor appetite, nausea, and vomiting. When complications arise, symptoms may include fever, jaundice, and bleeding. 

The cause of liver hemangiomas isn’t well understood, but there is thought to be a genetic component. Additionally, hormonal factors (estrogen) may play a role. In terms of diagnosis, medical professionals use imaging techniques to visualize the liver. 

Adult women are most at risk of developing a liver hemangioma. Factors like long-term steroid use, oral contraceptive use, and hormone replacement therapy are risks for complications from the condition.  

Complications are uncommon but include inflammatory, mechanical, bleeding, and degenerative issues. Most liver hemangiomas do not require treatment, but when they do, options include restricting blood flow, surgical removal, and radiotherapy.

Frequently asked questions

How common are liver hemangiomas?

Liver hemangiomas are the most common non-cancerous liver tumor. Despite that, it is difficult to estimate precisely how common they are, as many people living with a liver hemangioma have no idea that they have the condition. The current data estimates that overall incidence in the general population could range between 7% to 20%. 

The prevalence of this condition is much higher in females than males, with an estimated ratio of 5:1. The highest prevalence of the initial diagnosis is in women aged 30 to 50 years old. 

What do hepatic hemangiomas look like?

Hepatic hemangiomas are only seen on imaging. They typically appear as a well-defined bright or dark spot. When removed, they may appear as a highly vascular (blood-filled) lumpy mass.

Should I be worried about a liver hemangioma?

The short answer is that you should not be worried about liver hemangioma in most cases. Many people go their whole lives not even realizing they have one. If your doctor happens to find a liver hemangioma, they may monitor you to ensure it isn’t getting bigger. However, unless you have symptoms or complications, concerns are usually minimal.

It is best to speak to your doctor if you have any concerns.