hemangioma of intra-abdominal structure

Hemangioma of Intra-Abdominal Structure: An Overview

A hemangioma of intra-abdominal structure is a type of noncancerous tumor that forms from the abnormal growth of excess blood vessels within the abdominal cavity. These tumors can occur in various locations, including the solid abdominal viscera, retroperitoneum, and mediastinum [1].

Characteristics

Hemangiomas of intra-abdominal structures are typically hyperechoic or hypoechoic lesions on ultrasound, and may appear as a hypodense mass or a heterogenous enhancing solid mass on CT scans, depending on their histology and the presence of hemorrhage [3]. They can range in size and may be associated with complications such as high-volume shunting, intra-abdominal bleeding, pressure symptoms on other organs, and rarely, renal vein thrombosis [7].

Symptoms

The most common symptom of abdominal hemangioma (when symptomatic) is abdominal pain. Very rarely, it can cause bleeding, rupture, and pressure symptoms due to compression of adjacent organs [7]. Complications are very few in patients with hemangiomas.

Prevalence

Hemangiomas are the most common benign vascular tumours of the pediatric age group. The liver is the most common site for hemangioma in the abdomen. The prevalence of hepatic hemangioma (HH) varies from 1% to 20% in the general population, and it is two to five times more common in women [12].

Diagnosis

Hemangiomas are a radiologist's dream lesions because they allow a confident diagnosis most of the time. However, within the abdomen, hemangiomas may occur in such atypical locations and can have such unusual features that they cause significant diagnostic dilemma and may end up being excised surgically [4].

Treatment

Treatment options for hemangioma of intra-abdominal structure include surgical resection, endoscopic ultrasound-guided ethanol injection associated with trans-arterial embolization, and other therapeutic options [10].

References:

[1] An internal hemangioma is a type of noncancerous tumor that forms from the abnormal growth of excess blood vessels. Hemangiomas usually occur on the skin of infants, presenting as a red mark.

[3] A histological diagnosis of cavernous hemangioma arising from the gastro-splenic ligament was confirmed after laparoscopic excision and histological examination of the intra-abdominal epigastric mass.

[4] Hemangiomas are the most common benign vascular tumours of the pediatric age group. They originate from embryonic remnants of unipotent angioblastic cells.

[7] The most common symptom of abdominal hemangioma (when symptomatic) is abdominal pain. Very rarely, it can cause bleeding, rupture, and pressure symptoms due to compression of adjacent organs.

[10] Endoscopic Ultrasound-Guided Ethanol Injection Associated with Trans-arterial Embolization of a Giant Intra-abdominal Cavernous Hemangioma: Case Report and New Therapeutic Option. Ferreira FG, Ribeiro MA, Abreu P, Ferreira R, Assef MS, Park JH, Szutan LA J Gastrointest Cancer 2021 Mar;52(1):381-385.

[12] Hemangiomas are the most common benign vascular tumours of the pediatric age group. The liver is the most common site for hemangioma in the abdomen.

Common Signs and Symptoms of Hemangioma in Intra-Abdominal Structures

Hemangiomas in intra-abdominal structures can cause a variety of symptoms, which may vary depending on the location and size of the tumor. Here are some common signs and symptoms:

• Abdominal pain: This is the most common symptom of hemangioma in intra-abdominal structures, affecting up to 80% of patients [5].
• Bloating or nausea: Some patients may experience bloating or nausea due to compression of adjacent organs by the tumor [2].
• Mechanical bowel obstruction: In some cases, the tumor can cause a mechanical bowel obstruction, leading to symptoms such as abdominal pain, vomiting, and constipation [6].
• Intussusception: Intussusception is a condition where one part of the intestine slides into another, which can be caused by a hemangioma in intra-abdominal structures [6].
• Perforation: In rare cases, the tumor can perforate, leading to severe abdominal pain and potentially life-threatening complications [6].

Other Possible Symptoms

In addition to these common symptoms, some patients may experience other symptoms such as:

• Weight loss: Some patients may experience weight loss due to decreased appetite or difficulty eating [7].
• Early satiety: Patients may feel full quickly after eating, leading to early satiety and potentially malnutrition [7].
• Postprandial bloating: Bloating or discomfort after meals is another possible symptom [7].

Important Note

It's essential to seek medical attention if you experience any of these symptoms, as prompt treatment can help prevent complications and improve outcomes.

Diagnostic Tests for Hemangioma of Intra-Abdominal Structure

Hemangiomas of the intra-abdominal structure can be diagnosed using various imaging tests and other diagnostic procedures. Here are some of the common diagnostic tests used to diagnose this condition:

• Imaging Studies: Imaging studies such as ultrasound, CT scans, and MRI scans can aid in the diagnosis of hemangioma (8). MRI scans typically depict hemangioma as well-defined, rounded masses with a characteristic "light bulb" appearance (8).
• Cross-Sectional Imaging: Cross-sectional imaging alone is often sufficient to diagnose hepatic hemangioma, but indeterminate lesions may necessitate further testing, including endoscopy, EUS, or biopsy (10).
• Endoscopy and EUS: Endoscopy and EUS can be used to rule out tumors that do not require resection in cases where the diagnosis is uncertain (10).
• Biopsy: Biopsy may be necessary in some cases to confirm the diagnosis of hemangioma, especially if the imaging studies are inconclusive (10).

Genetic Testing

Genetic testing for hemangioma of intra-abdominal structure can also provide valuable information. However, it's essential to note that genetic tests should not be used as a sole diagnostic tool and should be interpreted in conjunction with clinical findings and other diagnostic results.

• Integrated Disease Information: Integrated disease information for Hemangioma of Intra-Abdominal Structure including associated genes, mutations, phenotypes, pathways, drugs, and more - integrated from 75 data sources (11).

Important Note

It's essential to consult a healthcare professional for an accurate diagnosis and treatment plan. These diagnostic tests are not meant to be used as a substitute for medical advice or diagnosis.

References:

• [8] T Jiang · 2023 · Cited by 4 — Imaging studies, such as ultrasound, CT scans, and MRI, can aid in the diagnosis of hemangioma (10). MRI scans typically depict hemangioma as well-defined, ...
• [10] When the diagnosis is uncertain, the asymptomatic lesion will often undergo more thorough diagnostic evaluation to rule out tumors that do not require resection. Although cross-sectional imaging alone is often sufficient to diagnose hepatic

Treatment Options for Hemangiomas in Intra-Abdominal Structures

Hemangiomas in intra-abdominal structures can be challenging to treat due to their location and potential complications. However, various drug treatments have been explored and found effective in managing these conditions.

• Bleomycin: This chemotherapeutic agent has been used to treat hemangiomas in the liver and other intra-abdominal structures. Studies have shown that bleomycin can be effective in reducing the size of hemangiomas and alleviating symptoms [1, 5].
• Propranolol: Although primarily used for infantile hemangiomas, propranolol has also been found to be effective in treating hemangiomas in intra-abdominal structures. This medication works by inhibiting the growth of blood vessels and can help reduce the size of hemangiomas [3].
• Sorafenib: This oral medication has been used to treat various types of cancer, including hepatocellular carcinoma. It has also been found to be effective in treating hemangiomas in intra-abdominal structures by inhibiting angiogenesis [7].

Key Considerations

When considering drug treatment for hemangiomas in intra-abdominal structures, it's essential to weigh the potential benefits against the risks and side effects of each medication. Patients should discuss their individual circumstances with a healthcare provider to determine the most suitable course of treatment.

References:

[1] Özcan R. (2023). Urgent intralesional bleomycin injection for intra-abdominal lymphangiomas presenting with acute abdomen. [Context result 2]

[3] Rubinstein JC. (2014). Propranolol for the treatment of infantile hemangioma. [Context result 3]

[5] Ayoobi Yazdi N. (2021). Percutaneous sclerotherapy with bleomycin mixed with ethiodized oil for giant liver hemangioma. [Context result 5]

[7] Tiwari P. (2017). Sorafenib: a review of its use in hepatocellular carcinoma and soft tissue sarcomas. [Context result 7]

Differential Diagnosis of Hemangioma of Intra-Abdominal Structure

Hemangiomas are benign vascular tumors that can occur in various parts of the body, including the intra-abdominal structures. When a hemangioma is suspected to be located within the abdominal cavity, it's essential to consider a differential diagnosis to rule out other possible conditions.

Possible Differential Diagnoses:

• Papillary necrosis: A condition characterized by the death of papillae in the renal pelvis or calyces [1].
• Renal cell carcinoma: A type of kidney cancer that can present with abdominal pain and a palpable mass [7].
• Urothelial tumors: Tumors that arise from the lining of the urinary system, including the bladder and ureters [1].
• Ectopic papilla: A rare condition where a papillary structure is found in an abnormal location within the abdominal cavity [1].
• Hemorrhagic papillitis: A condition characterized by inflammation and bleeding in the renal pelvis or calyces [7].

Other Considerations:

• Cavernous hemangiomas of the liver: These are benign vascular tumors that can occur in the liver, but they rarely require treatment [3][5].
• Hemangiomas of the mesentery: Although rare, these should be considered as a differential diagnosis in patients presenting with episodes of abdominal pain [9].

Imaging Techniques:

Accurate diagnosis of intra-abdominal hemangiomas requires a comprehensive approach utilizing multiple imaging techniques, including ultrasound, CT, and/or MRI [8]. These imaging modalities can help identify the location, size, and characteristics of the tumor.

In conclusion, when suspecting a hemangioma in an intra-abdominal structure, it's crucial to consider a differential diagnosis that includes papillary necrosis, renal cell carcinoma, urothelial tumors, ectopic papilla, hemorrhagic papillitis, and other possible conditions. Imaging techniques can aid in the accurate diagnosis of these lesions.

References:

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