Giant hepatic hemangiomas, though often asymptomatic, may require intervention if rapid growth occurs. The imaging studies including the computed tomography, magnetic resonance imaging, and ultrasonography, and so on are effective for the diagnosis and the management of this tumor; however, due to its size and various patterns of these studies, we need to carefully consider the therapeutic methods. Compared to the cost needed for these modalities, recently developed and approved Perflubutane- (Sonazoid-) based contrast agent enhanced ultrasonography is reasonable and safe. The major advantage is the real-time observation of the vascular structure and function of the Kupffer cells. By this procedure, we can carefully follow the tumor growth or character change in a hemangioma and decide the timing of therapeutic intervention, since abdominal pain, abdominal mass, consumptive coagulopathy, and hemangioma growth are the signs for the therapeutic intervention. We reviewed recent reports about Sonazoid-based enhancement and also showed the representative images collected in our department. This is the first review showing the detailed findings of the giant hemangiomas using Perflubutane (Sonazoid). This review will help the physician in making the decision, and we hope that Sonazoid will gain widespread acceptance in the near future. 1. Introduction Hepatic hemangiomas are the most common benign tumors of the liver and usually do not grow [1]. In cases with giant hepatic hemangiomas, intervention is necessary since clinical symptoms due to rapid growth are present [2, 3]. Detailed follow-up imaging examinations of giant hepatic hemangiomas are essential for relevant medical treatment or surgical intervention. Although computed tomography (CT) or magnetic resonance imaging (MRI) is useful for diagnosing hepatic hemangioma, these modalities are expensive and there are several risks associated with the contrast agents used as well as radiation exposure. There are many recent reports describing contrast-enhanced ultrasonography (US) as being safe, inexpensive, and useful for the diagnosis of focal liver lesions [4, 5]. Perflubutane (Sonazoid) is a new contrast agent for contrast-enhanced US approved only Japan. The only contraindication to its use is an allergy to eggs. Sonazoid contrast-enhanced US is very useful for the diagnosis of hemangioma of the liver, since real-time images can be shown that is unable to be obtained by CT or MRI, and yielding information about Kupffer cell function [6, 7]. However, there have been few reports describing Sonazoid
References
[1]
J. A. Mungovan, J. J. Cronan, and J. Vacarro, “Hepatic cavernous hemangiomas: lack of enlargement over time,” Radiology, vol. 191, no. 1, pp. 111–113, 1994.
[2]
M. N. Sinanan and T. Marchioro, “Management of cavernous hemangioma of the liver,” American Journal of Surgery, vol. 157, no. 5, pp. 519–522, 1989.
[3]
L. Belli, L. De Carlis, C. Beati, G. Rondinara, V. Sansalone, and G. Brambilla, “Surgical treatment of symptomatic giant hemangiomas of the liver,” Surgery Gynecology and Obstetrics, vol. 174, no. 6, pp. 474–478, 1992.
[4]
C. F. Dietrich, J. C. Mertens, B. Braden, G. Schuessler, M. Ott, and A. Ignee, “Contrast-enhanced ultrasound of histologically proven liver hemangiomas,” Hepatology, vol. 45, no. 5, pp. 1139–1145, 2007.
[5]
T. V. Bartolotta, A. Taibbi, M. Midiri, and R. Lagalla, “Focal liver lesions: contrast-enhanced ultrasound,” Abdominal Imaging, vol. 34, no. 2, pp. 193–209, 2009.
[6]
V. Salvatore, A. Borghi, and F. Piscaglia, “Contrast-enhanced ultrasound for liver imaging: recent advances,” Current Pharmaceutical Design, vol. 18, no. 15, pp. 2236–2252, 2012.
[7]
K. Hatanaka, M. Kudo, Y. Minami et al., “Differential diagnosis of hepatic tumors: value of contrast-enhanced harmonic sonography using the newly developed contrast agent, Sonazoid,” Intervirology, vol. 51, no. 1, pp. 61–69, 2008.
[8]
K. M. Horton, D. A. Bluemke, R. H. Hruban, P. Soyer, and E. K. Fishman, “CT and MR imaging of benign hepatic and biliary tumors,” Radiographics, vol. 19, no. 2, pp. 431–451, 1999.
[9]
F. Caseiro-Alves, J. Brito, A. E. Araujo et al., “Liver haemangioma: common and uncommon findings and how to improve the differential diagnosis,” European Radiology, vol. 17, no. 6, pp. 1544–1554, 2007.
[10]
S. S. Yoon, C. K. Charny, Y. Fong et al., “Diagnosis, management, and outcomes of 115 patients with hepatic hemangioma,” Journal of the American College of Surgeons, vol. 197, no. 3, pp. 392–402, 2003.
[11]
D. Erdogan, O. R. C. Busch, O. M. Van Delden et al., “Management of liver hemangiomas according to size and symptoms,” Journal of Gastroenterology and Hepatology, vol. 22, no. 11, pp. 1953–1958, 2007.
[12]
M. S. Duxbury and O. J. Garden, “Giant haemangioma of the liver: observation or resection,” Digestive Surgery, vol. 27, no. 1, pp. 7–11, 2010.
[13]
T. Schnelldorfer, A. L. Ware, R. Smoot, C. D. Schleck, W. S. Harmsen, and D. M. Nagorney, “Management of giant hemangioma of the liver: resection versus observation,” Journal of the American College of Surgeons, vol. 211, no. 6, pp. 724–730, 2010.
[14]
J. Choi, Y. J. Lee, D. W. Hwang, S. H. Chon, A. Nagpal, and K. M. Park, “Surgical treatment of giant hepatic hemangiomas: technical point of view,” American Surgeon, vol. 77, no. 1, pp. 48–54, 2011.
[15]
T. Uetama, H. Yoshida, A. Hirakata et al., “A symptomatic giant hepatic hemangioma treated with hepatectomy,” Journal of Nippon Medical School, vol. 78, no. 1, pp. 34–39, 2011.
[16]
H. Y. Ho, T. H. Wu, M. C. Yu, W. C. Lee, T. C. Chao, and M. F. Chen, “Surgical management of giant hepatic hemangiomas: complications and review of the literature,” Chang Gung Medical Journal, vol. 35, no. 1, pp. 70–78, 2012.
[17]
H. Jiang, Z. Chen, P. Prasoon, H. Wu, and Y. Zeng, “Surgical management for giant liver hemangiomas greater than 20 cm in size,” Gut and Liver, vol. 5, no. 2, pp. 228–233, 2011.
[18]
H. H. Watzke, W. Linkesch, and U. Hay, “Giant hemangioma of the liver (Kasabach-Merritt syndrome): successful suppression of intravascular coagulation permitting surgical removal,” Journal of Clinical Gastroenterology, vol. 11, no. 3, pp. 347–350, 1989.
[19]
J. H. Sewell and K. Weiss, “Spontaneous rupture of hemangioma of the liver. A review of the literature and presentation of illustrative case,” Archives of Surgery, vol. 83, pp. 729–733, 1961.
[20]
H. Papafragkakis, M. Moehlen, M. T. Garcia-Buitrago, B. Madrazo, E. Island, and P. Martin, “A case of a ruptured sclerosing liver hemangioma,” International Journal of Hepatology, vol. 2011, Article ID 942360, 5 pages, 2011.
[21]
Q. Zeng, Y. Li, Y. Chen, Y. Ouyang, X. He, and H. Zhang, “Gigantic cavernous hemangioma of the liver treated by intra-arterial embolization with pingyangmycin-lipiodol emulsion: a multi-center study,” CardioVascular and Interventional Radiology, vol. 27, no. 5, pp. 481–485, 2004.
[22]
A. A. Bandeira Ferraz, M. J. Antunes Sette, M. Maia et al., “Liver transplant for the treatment of giant hepatic hemangioma,” Liver Transplantation, vol. 10, no. 11, pp. 1436–1437, 2004.
[23]
M. Meguro, Y. Soejima, A. Taketomi et al., “Living donor liver transplantation in a patient with giant hepatic hemangioma complicated by Kasabach-Merritt syndrome: report of a case,” Surgery Today, vol. 38, no. 5, pp. 463–468, 2008.
[24]
N. Akamasu, Y. Sugawara, M. Komagome et al., “Giant liver hemangioma resected by trisectorectomy after efficient volume reduction by transcatheter arterial embolization: a case report,” Journal of Medical Case Reports, vol. 4, article 283, 2010.
[25]
K. Vassiou, H. Rountas, P. Liakou, D. Arvanitis, I. Fezoulidis, and K. Tepetes, “Embolization of a giant hepatic hemangioma prior to urgent liver resection. Case report and review of the literature,” CardioVascular and Interventional Radiology, vol. 30, no. 4, pp. 800–802, 2007.
[26]
H. Suzuki, Y. Nimura, J. Kamiya et al., “Preoperative transcatheter arterial embolization for giant cavernous hemangioma of the liver with consumption coagulopathy,” American Journal of Gastroenterology, vol. 92, no. 4, pp. 688–691, 1997.
[27]
M. Kudo, K. Hatanaka, and K. Maekawa, “Newly developed novel ultrasound technique, defect reperfusion ultrasound imaging, using Sonazoid in the management of hepatocellular carcinoma,” Oncology, vol. 78, no. 1, pp. 40–45, 2010.
[28]
M. J. McLoughlin, “Angiography in cavernous hemangioma of the liver,” The American Journal of Roentgenology, Radium Therapy, and Nuclear Medicine, vol. 113, no. 1, pp. 50–55, 1971.
[29]
E. Hamaloglu, H. Altun, A. Ozdemir, and A. Ozenc, “Giant liver hemangioma: therapy by enucleation or liver resection,” World Journal of Surgery, vol. 29, no. 7, pp. 890–893, 2005.
