Hepatic hemangioma differential diagnosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Nawal Muazam M.D.[2]
Overview
Hepatic hemangioma must be differentiated from other diseases such as hepatic abscess, hepatocellular carcinoma, hepatic cyst, and hemangioendothelioma.[1]
Hepatic hemangioma differential diagnosis
Hepatic hemangioma must be differentiated from other diseases such as:[1]
- Hepatic metastases
- Hypervascular hepatic metastases show marked early enhancement with a continuous ring
- That on later images fills in centrally
- Progressive centripetal fill-in may occur on delayed phases
- Hepatocellular carcinoma
- Hepatic cyst
- Hepatic abscess
- Regenerative nodules/dysplastic nodules
- Cystic hepatic or biliary neoplasm
- Hemangioendothelioma
Differentiating Hepatic hemangioma from other causes of jaundice and abdominal pain
Hepatic hemangioma must be differentiated from other diseases that cause jaundice, abdominal pain, weight loss, and fever such as Gallbladder cancer, hepatocellular carcinoma, pancreatic cancer, cholecystitis, choledochitis and liver fluke infections.
Abbreviations:
RUQ= Right upper quadrant of the abdomen, LUQ= Left upper quadrant, LLQ= Left lower quadrant, RLQ= Right lower quadrant, LFT= Liver function test, SIRS= Systemic inflammatory response syndrome, ERCP= Endoscopic retrograde cholangiopancreatography, IV= Intravenous, N= Normal, AMA= Anti mitochondrial antibodies, LDH= Lactate dehydrogenase, GI= Gastrointestinal, CXR= Chest X ray, IgA= Immunoglobulin A, IgG= Immunoglobulin G, IgM= Immunoglobulin M, CT= Computed tomography, PMN= Polymorphonuclear cells, ESR= Erythrocyte sedimentation rate, CRP= C-reactive protein, TS= Transferrin saturation, SF= Serum Ferritin, SMA= Superior mesenteric artery, SMV= Superior mesenteric vein, ECG= Electrocardiogram
| Disease | Clinical manifestations | Diagnosis | Comments | |||||||||||||
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| Symptoms | Signs | |||||||||||||||
| Abdominal Pain | Fever | Rigors and chills | Nausea or vomiting | Jaundice | Constipation | Diarrhea | Weight loss | GI bleeding | Hypo-
tension |
Guarding | Rebound Tenderness | Bowel sounds | Lab Findings | Imaging | ||
| Cholangiocarcinoma | RUQ | + | − | + | + | − | − | + | − | − | − | + | Normal |
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| Hepatocellular carcinoma/Metastasis | RUQ | + | − | + | + | + | + | + | + | + | − | + |
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Other symptoms: | |
| Pancreatic carcinoma | MidEpigastric | − | − | + | + | + | − | + | − | − | − | + | Normal |
Skin manifestations may include: | ||
| Focal nodular hyperplasia | Diffuse | ± | − | − | ± | − | − | + | + | − | − | − | Normal |
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| Disease | Abdominal Pain | Fever | Rigors and chills | Nausea or vomiting | Jaundice | Constipation | Diarrhea | Weight loss | GI bleeding | Hypo-
tension |
Guarding | Rebound Tenderness | Bowel sounds | Lab Findings | Imaging | Comments |
| Gallbladder cancer | Midepigastric | − | − | + | + | − | + | + | − | − | − | − | Normal |
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| Liver hemangioma | Intermittent RUQ | − | − | + | + | − | − | − | − | − | − | − | Normal |
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| Liver abscess | RUQ | + | − | + | + | − | − | + | − | − | − | − | Normal |
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| Cirrhosis | RUQ+Bloating | + | − | + | + | − | − | + | − | − | − | − | Normal |
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US
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| Inflammatory lesions | RUQ | ± | − | + | + | − | − | − | − | − | − | − | Normal |
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US
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References
- ↑ 1.0 1.1 Differential diagnosis of hepatic hemangioma. Dr Yuranga Weerakkody et al. Radiopaedia (2015). http://radiopaedia.org/articles/hepatic-haemangioma-3. Accessed on October 26, 2015