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- W1796335972 abstract "Although most hemangiomas in infants undergo spontaneous involution, a few are life-endangering, either from massive hemorrhage or from necrosis leading to arteriovenous shunting and cardiac failure. The majority of reported cases of giant intrahepatic hemangioma have been fatal (1–4, 7, 12–14, 18,20), with congestive heart failure as the usual terminal event. The high-dosage intravenous urogram and its resultant “total-body opacification” (17) proved diagnostic in two cases seen at the Babies Hospital, as the hemangioma pooled the contrast agent on early films after injection. In addition, transumbilical aortography was of help in delineating the tumor and transumbilical venography aided in outlining the normal remaining liver. Case Reports CASE I (B. H.): Following a normal birth, a 3,470-g male infant was noted to have petechiae, jaundice, abdominal distension, and a right abdominal mass. Upon physical examination the mass was moderately firm and extended 8 cm below the right costal margin. A Grade 3/6 systolic murmur was observed. The clinical diagnosis was either neuroblastoma or hepatoma; congenital heart disease was also suspected. Laboratory tests included a moderately low platelet count (59,000/-mm3) a hemoglobin of 13.6 g per 150 ml, and an electrocardiogram consistent with right and possibly left ventricular hypertrophy. A cardiac consultant thought the infant probably had a left-to-right shunt, and digitalis was given as the respiratory rate rose from 60 to 80/minute and the pulse from 120 to 170/minute. A wide pulse pressure was noted with a blood pressure of 108/30. Chest roentgenograms showed a huge globular mediastinal image (thought to be thymus and heart) with clear lungs. The abdominal films demonstrated faint calcification in the right abdomen with displacement of gas-filled bowel from this area. An intravenous urogram (4 ml/kg of 50 per cent sodium diatrizoate) revealed on films at one and three minutes (Fig. 1) opacification of a dense zone within the right side of the liver surrounding a central lucent area. At ten minutes, these findings had faded, and normal right and left kidneys were seen without signs of displacement or involvement (Fig. 2). The diagnosis was made of a right hepatic mass with both hyperemic and avascular compartments. With the low platelet count and cardiac findings, it was thought this was a huge hepatic hemangioma with features both of platelet sequestration and of shunting with cardiac failure. The surgeon was preparing to resect the right hepatic lobe but the infant died. Postmortem examination confirmed the diagnosis of right hepatic giant hemangioma with capillary and cavernous features, and with areas of cystic necrosis, hemorrhage, and thrombosis. Postmortem aortography (Fig. 3) revealed huge lakes of contrast material surrounding the cystic spaces with visualization of a giant hepatic vein draining the mass." @default.
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- W1796335972 date "1969-06-01" @default.
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- W1796335972 title "Giant Hepatic Hemangioma with Cardiac Failure in the Newborn Infant" @default.
- W1796335972 doi "https://doi.org/10.1148/92.7.1523" @default.
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