Cavernous hemangioma on ultrasound. Difficulties in diagnosing giant cavernous hemangioma of the liver, clinical example. Physical methods for removing hemangiomas

Liver hemangioma in children and adults is a benign tumor that can “grow” from any vascular link inside the liver (arteries, veins, capillaries). It occurs in any age group of the population and ranks second among liver tumors.

Women are more susceptible to the disease, which is associated with the effect of estrogen on vascular system(improve metabolic processes, thereby “feeding” the tumor). IN childhood, When hormonal background weak, hemangioma can disappear on its own (80% of cases).

Signs of liver hemangioma

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The tumor is detected by chance during an examination of organs abdominal cavity(ultrasound, CT). It is a local proliferation of a vascular area no more than 5 cm in size. It is more often found in right lobe liver in the form of a single formation. In most cases it does not bother the patient.

Why is a vascular tumor dangerous?

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The liver has an abundant blood supply, blood flow per minute is 1.5 liters. The altered section of the vessel may not withstand such a load and rupture.

Factors contributing to hemangioma rupture:

• Increased systemic blood pressure (hypertension).
• Increased pressure in the portal vein system (liver cirrhosis).

By portal vein The main volume of blood enters the liver (70-75%), the rest - through the hepatic arteries.

• Increased intra-abdominal pressure (in severe physical activity, cough, constipation).
• Blunt abdominal trauma.

The larger the tumor, the higher the risk of rupture and intra-abdominal bleeding. Possible development fatal outcome in 75% of cases.

Hemangioma can thrombose, which can result in:

• sclerosis;
• inflammation;
• suppuration of a tumor (liver abscess).

Classification of liver hemangiomas

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• According to the structure of the tumor:

There are two most common forms:

a) Capillary - represents chaotically located tangles of liver capillaries, between the loops of which fine-mesh spaces are formed. Microscopically, these areas have the usual structure of the capillary of the liver tissue, only the course of the vessel is changed. On ultrasound it is determined in the form of a formation with a round shape. This type of hemangioma can be multiple. Rarely exceeds 3 cm in size.

b) Cavernous - a new formation of the liver, the cells of which are larger. It has a dough-like consistency; ultrasound shows the formation of uneven outlines; in the center of such hemangiomas, a cyst filled with liquid contents often forms. The risk of cancerous degeneration and rupture in such tumors is higher.

c) Lymphangiomas - grow from lymphatic vessels.

• According to the course of the disease:

a) Asymptomatic

b) There are clinical manifestations, but no complications.

c) Complicated form.

d) Atypical course of the disease, against the background of concomitant pathology.

Causes of liver hemangioma

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• Is congenital pathology according to many scientists. Associated with impaired embryonic development of the vascular bed.
• Hormonal theory.

Elevated estrogen levels provoke tumor development.

• Mechanical impact - injury.

Symptoms of liver hemangioma

Clinical manifestations depends on:

• tumor size;
• localization;
• stages of development;
• degree of destruction of liver tissue;
• addition of complications.

In 70% of cases, the disease occurs in a latent (asymptomatic) form. As the size of the tumor increases, it can put pressure on adjacent organs, causing a number of symptoms:

• feeling of heaviness, discomfort and pain in the right hypochondrium;
• nausea and vomiting;
• liver enlargement;
• flatulence;
• disorders of appetite, stool and sleep;
• change in skin color - yellowness (observed when the bile ducts are compressed);
• increased temperature due to inflammation in the liver.

When a hemangioma ruptures, signs of intra-abdominal bleeding come to the fore:

• sharp pain in the abdomen;
• decline blood pressure, increased heart rate;
• pale skin;
• weakness.

The occurrence of such symptoms requires emergency hospitalization of a person in a surgical hospital.

Diagnosis of liver hemangioma

The diagnosis is confirmed using instrumental studies:

• Ultrasound of the liver

The examination shows round formations with heterogeneous contents.

Allows you to detect even small hemangiomas. Often performed using contrast enhancement of the liver vessels. It very well determines the structure of the tumor and its exact location.

• Liver scintigraphy

Isotopes are injected intravenously and a two-dimensional image of the liver is obtained by measuring the radiation they emit.

• Angiography of the vessels of the celiac trunk (celiacography)

The contrast agent is injected through femoral artery, it reaches the aorta, then enters the celiac trunk and along its branches begins to fill the main arteries of organs, including the liver.

Thanks to this method, it is possible to determine whether the tumor is vascular or parenchymal, malignant or benign (pharmaceuticals that act on blood vessels are additionally administered).

Treatment of liver hemangioma

Tumor formations less than 5 cm with an asymptomatic course do not require treatment. But every 3 months they undergo an ultrasound of the abdominal organs to track the dynamics of hemangioma growth.

There are three types of treatment for liver hemangioma:

A) Conservative treatment(diet, medications, herbal medicine).

B) Parasurgical methods

B) Surgical methods

Diet for liver hemangioma

A specific nutritional system has not been developed, so the principles of diet for diseases of the liver and biliary tract are used.

1. Fractional meals 5-6 times a day in small portions
2. Eliminate alcohol, carbonated drinks, coffee
3. Limit consumption of fatty, smoked foods.
4. Minimize salt and hot spices
5. Drink more water(30ml/kg body weight)
6. Eat more fiber in the form of vegetables and fruits
7. Give preference to dairy products low content fat
8. From animal products, it is better to choose low-fat fish, white poultry, and chicken liver.

Drug treatment

Is preparatory stage for parasurgical and surgical types treatment. Apply hormonal drugs, the dose and period of use are calculated by the doctor individually. Thanks to this, the tumor decreases in size and stops growing.

Phytotherapy

• Oat seed decoction

Pour 1 liter of boiling water over the seeds and leave for 10 hours. Boil for 30 minutes, filter, add 1 liter of boiling water. The course of treatment is 45 days. Half a glass 3 times a day 15 minutes before meals.

• Lime tea

• Infusion of bitter wormwood

Sold in a pharmacy. Take 12 drops 3 times a day. The course of treatment is 2 months. You must complete 3 courses per year.

• Raw potatoes

Eat 50 g daily 30 minutes before meals.

Parasurgical methods

1) Laser treatment of the tumor.

2) Electrocoagulation.

The introduction of ferromagnetic particles creates a local electromagnetic field in the tumor focus, it heats up and its disintegration and subsequent healing occurs.

Surgical methods

1) Resection of a segment or lobe of the liver with tumor lesions.

2) Reducing tumor blood flow by introducing an artificial embolus or sclerosing agent into the afferent vessel.

– benign vascular formation resulting from an embryonic developmental disorder blood vessels. Hemangioma in children has the appearance of a red, purple or bluish spot with a flat or raised surface above the skin; hemangiomas are prone to intensive growth and bleeding. Examination for hemangioma in children includes consultation with a pediatric dermatologist and surgeon, x-ray of the anatomical area where the vascular tumor is located, ultrasound, angiography, and examination of the state of the blood coagulation system. Hemangioma in children can be subjected to laser or surgical removal, radiation therapy, electrocoagulation, cryotherapy, sclerotherapy, hormonal treatment and etc.

General information

Hemangioma in children is a benign tumor of vascular tissue, vascular birthmark, vascular malformation. In pediatrics and pediatric surgery, hemangiomas are found in 1.1–2.6% of newborns and 10% of children in the first year of life. Hemangioma is the most common benign tumor of the skin and mucous membranes in children, accounting for about 50% of all soft tissue tumors in childhood. Hemangiomas occur 2-3 times more often in girls.

Despite its benign nature, hemangioma in children is prone to rapid progressive growth. Growing in breadth and depth, hemangioma can germinate and destroy surrounding tissues; cause dysfunction of the organs of vision, hearing, breathing, etc.; become infected, ulcerate and cause bleeding. In addition, the presence of hemangioma in a child represents a significant cosmetic defect.

Causes of hemangioma in children

The reasons for the formation of hemangiomas in children are unknown, however, numerous observations and generalization of data have made it possible to put forward a number of assumptions. Due to the fact that hemangiomas occur in children infancy Probably, a prerequisite for this is a violation of vascular development in the embryonic period of development.

In turn, a violation of vasculogenesis can occur under the influence of a pregnant woman taking certain medications taken during pregnancy viral diseases(flu, ARVI, etc.), unfavorable environmental conditions. It is possible that the appearance of vascular tumors is associated with hormonal regulation, since there is a clear gender dependence - hemangiomas occur more often in girls.

Classification of hemangioma in children

Based on morphological characteristics, simple (capillary), cavernous, combined and mixed hemangioma in children is distinguished.

Simple hemangioma arises from capillaries; located on the surface of the skin; has clear boundaries, a flat, tuberous-nodular, tuberous-flattened surface; red or purple-bluish color. A simple hemangioma in children turns pale when pressure is applied to the spot, and then regains its color.

Cavernous or cavernous hemangioma in children is located subcutaneously in the form of a tuberous nodular formation. It has a soft-elastic consistency and consists of cavities filled with blood. The top of the cavernous hemangioma is covered with unchanged or bluish skin. When pressure is applied to the node, due to the outflow of blood, the hemangioma turns pale and collapses; when the child strains, coughs and cries, it tenses and increases in size (erectile symptom caused by the flow of blood into the cavernous cavities).

Combined hemangioma in children has the characteristics of a simple and cavernous tumor, and has cutaneous and subcutaneous parts. Clinical manifestations depend on the predominance of the capillary or cavernous component.

Mixed hemangioma in children has a complex structure and contains elements of vascular and other tissues (connective, nervous, lymphoid). Mixed type hemangiomas include angiofibromas, angioneuromas, hemlymphangiomas, etc. Their color, consistency and appearance depend on the tissues that make up the vascular tumor.

Hemangiomas in children can be single or multiple; be small, large or extensive. In 95% of cases, children are diagnosed with simple hemangioma. With the flow pathological process distinguish between hemangiomas and rapid growth, slow growth and lack of growth.

Symptoms of hemangioma in children

In most cases, hemangioma in a child is detected immediately after birth or in the first weeks of life; less often - during the first 2-3 months. Particularly intensive growth of hemangiomas in children occurs in the first half of life; in the future, as a rule, the growth of the vascular tumor slows down.

Hemangiomas in children (in decreasing frequency) can be localized in the scalp (especially on the back of the head), face (on the eyelids, cheeks, nose), oral cavity, genitals, upper torso, arms and legs, internal organs and bones .

Externally, hemangioma in children is a flat or raised above the skin, tuberous-flattened, tuberous-nodular or cavernous formation. The size of the spot can vary from 1-2 mm to 10-15 cm or more in diameter: in the latter case, the hemangioma occupies a large anatomical area. Hemangioma in children has various shapes and shades (from pale pink to burgundy-bluish). With skin hemangiomas in children, temperature asymmetry is clearly expressed - the vascular formation is hotter to the touch than the surrounding intact tissues.

The growth of hemangioma occurs not only in width, but also in depth, which can be accompanied by compression of tissues and disruption of the functions of neighboring organs. Hemangiomas in children are easily traumatized, causing the development of bleeding from the tumor, which can be difficult to stop. Other complications of hemangioma in children are ulceration and infection of the vascular tumor.

Simple hemangiomas in children can undergo spontaneous regression. In the process of spontaneous disappearance of hemangima, 3 stages are distinguished: until the end of the 1st year of life, early involution (from 1 to 5 years), late involution (until the end puberty). Regression of hemangioma in children begins with the appearance of blanching areas in the center of the tumor, which gradually spread from the center to the periphery. The process of spontaneous disappearance of hemangioma in children can take several years.

Diagnosis of hemangioma in children

A pediatrician, a pediatric surgeon, and a pediatric dermatologist take part in the examination of children with a vascular tumor. Depending on the topography of the hemangioma, the child may require additional consultation and examination with a pediatric ophthalmologist, pediatric otolaryngologist, pediatric gynecologist, pediatric urologist, pediatric dentist and other specialists.

Physical examination techniques include inspection, palpation, auscultation, and determination of the area of ​​hemangioma in a child. To identify Kasabach-Merritt syndrome, characterized by active growth of hemangioma, thrombocytopenia and blood clotting disorders, hemostasis was examined (coagulogram, platelet count).

In order to assess the depth of spread of hemangioma in children, its anatomical and topographical features and structure, an ultrasound scan of the skin tumor is performed to measure the blood flow velocity in the tumor parenchyma and peripheral vessels. To clarify the characteristics of the blood supply to hemangioma in children, angioarchitecture and relationships with other vessels, angiography is performed.

If it is necessary to determine the involvement of surrounding tissues, radiography of a particular anatomical area (bones of the skull, chest, orbits, etc.) can be performed.

Treatment of hemangioma in children

Hemangiomas in children located in the head and neck area are subject to early treatment (in the first weeks and months of life). oral cavity, anogenital area or tending to aggressive growth (increase in area by 2 times per week), non-regressive cavernous hemangiomas, as well as vascular formations complicated by bleeding, infection, necrosis. Watchful waiting is possible for simple hemangiomas in children that are not serious. cosmetic defect and the danger of complications; in the presence of signs of spontaneous regression of a vascular tumor. When choosing a treatment method for hemangioma in children, they are guided by the principles of achieving maximum oncological, functional and cosmetic results.

Point and superficial hemangiomas in children can be subjected to successful electrocoagulation, cryodestruction, and laser removal. Small cavernous and combined hemangiomas respond well to sclerotherapy. If there is a deeply located vascular tumor and it is impossible to remove it using less traumatic methods, they resort to surgical excision of the hemangioma in children within healthy tissue. Embolization is possible large vessel, feeding the hemangioma.

For hemangiomas that have a complex anatomical localization (for example, in the orbit or retrobulbar space) or occupy a large area, it is used radiation treatment(X-ray therapy). For extensive skin hemangiomas in children, hormonal corticosteroid therapy may be prescribed. IN difficult cases(with a deep location of the hemangioma in children, a large area of ​​damage, complex structure and hard-to-reach localization) a combination is possible various methods treatment: microwave irradiation magnetic field plus cryodestruction; hormone therapy plus surgery or X-ray therapy, etc.

Prognosis for hemangioma in children

In 6.7% of cases, hemangiomas in children progress during the first year of life, and then undergo spontaneous reverse development over several years. The outcome of the reverse development of hemangioma in children can be complete disappearance with a good cosmetic result, depigmentation of the vascular tumor, its flattening or scarring. The best cosmetic effect is achieved with the spontaneous disappearance of flat hemangiomas.

The decision on dynamic observation or treatment of hemangioma in children is made by pediatric surgeon Therefore, in all cases it is necessary to seek qualified help. Due to the fact that hemangiomas in children are often prone to rapid growth and various complications, in most cases active tactics are chosen. The possibilities of modern pediatric medicine allow you to choose optimal method treatment of hemangioma in children in order to achieve optimal functional and aesthetic results.

Almost 10% of children are born with red, bluish or brownish spots on the skin or mucous membranes, localized in various parts of the body.

In the vast majority of cases, they turn out to be benign neoplasms, the result of proliferation of the inner layer of small and medium-sized vessels (endothelium). That is why these formations are called angiomas or hemangiomas, that is, vascular tumors.

Skin hemangioma in children is the most common of all neoplasms, and the likelihood of its development in girls is 3 times greater than in boys.

Causes

These formations are mainly diagnosed in newborn infants and children in the first year of life, much less often their development begins in adulthood. Scientists have still not been able to accurately establish the causes of the growth vascular endothelium, but taking into account the age aspect of the manifestation of the disease, it is believed that the leading role is played by heredity and negative factors affecting the fetus during pregnancy.

Many negative influences during pregnancy can cause a local disruption of the formation of a normal vascular network in the skin of the unborn child and change the course of the structural formation of capillaries, arteries and veins.

Taking hemangiomas on the skin of a child can also provoke the appearance of medicines a woman, poor environmental conditions, acute respiratory infections or acute respiratory viral infections at any time.

Early signs

The favorite localization of hemangiomas is the skin. Much less often, neoplasms are diagnosed in internal organs(, kidneys, rectum,) or bone structures.

Most often, skin hemangioma in a child is located on the face, neck, scalp, genitals, and upper half of the body. Tumors can be small and large, single or multiple.

Depending on the structure of the neoplasm, the appearance of angiomas also differs. If the tumor is capillary, that is, consisting of overgrown capillaries, then it looks like a spot, flat or slightly raised, red, brown or red-bluish in color, turning pale when pressed.

The safest in this regard is capillary hemangioma. Having been discovered in early age baby, it very rarely progresses, but on the contrary begins to develop reversely: it gradually turns pale and decreases in size. Most of these tumors regress a few years after the birth of the child.

In addition, angiomas are dangerous due to the possibility of injury. The damaged surface begins to bleed, ulcerate and become entrance gate for infection. Subsequent to this inflammatory process ends with the formation of rough scar formations, aggravating the aesthetic defect.

Does skin hemangioma turn into cancer?

Theoretically, any benign tumor can transform into a malignant one. The factors contributing to malignancy (malignant degeneration) are quite diverse. The trigger point can be mechanical or physical injury, chemical exposure, or solar radiation.

But in clinical practice There have been no cases of hemangiomas of any type turning into cancer in childhood.

Diagnostics

With cutaneous and subcutaneous localization of vascular tumors, diagnosis does not cause difficulties. To determine the type of neoplasm, its structure and degree of danger, the following diagnostic steps are carried out:

1. Examination of the child, determination of the number, size, shape, color of the tumor.
2. Laboratory blood test.
3. Instrumental methods (ultrasound,).

Treatment

Therapeutic tactics depend on the type of hemangioma, size, location and are individual. If the neoplasm is of the capillary type, then in many cases the doctor adheres to a wait-and-see approach. In other cases, the choice is made between conservative and surgical treatment.

From medicinal methods Hormonal therapy for skin hemangioma in children (“Prednisolone”), as well as the use of beta-blockers (“Propranolol”) are widely used.

According to indications, cryodestruction of the tumor is carried out ( liquid nitrogen), mainly with a superficial location and any size.

Diathermoelectrocoagulation ( high temperature) is produced for point forms of neoplasms of any localization.

Sclerosis (introduction) special means into tumor structures) is especially effective for cavernous and combined angiomas.

Surgical excision in childhood is performed very rarely, only when it is impossible to use other methods. It is indicated for deep germination of cellular, cavernous, and combined angiomas.

Most preferable in children, as it is painless, non-invasive and has maximum effective method. It has a short rehabilitation period, has no age restrictions, and completely eliminates cosmetic defects without consequences.

Traditional methods play a role in therapy of this disease only a supporting role. Juice applied walnut and oak bark for sclerosis, onion or garlic juice for cauterization of blood vessels.

Possible complications in the future

Hemangioma of any type, with the exception of small capillary formations prone to regression, must be treated. An oncologist or surgeon chooses for the child in each specific case the best way therapy, which helps to get rid of the tumor forever.

If the skin lesion is not removed in time, there is a constant risk of injury, infection or bleeding, tumor growth and aggravation of the child’s psycho-emotional discomfort due to a cosmetic defect.

Forecast

Skin hemangioma in children always has a favorable prognosis for life and health. Modern methods of therapy make it possible to achieve absolutely positive aesthetic and clinical results.

Among modern methods Diagnosis of liver hemangioma is undoubtedly the leading method of magnetic resonance imaging (MRI). The disease belongs to the category benign tumors. The tumor is an irregular formation of intertwined blood vessels. Exactly irregular shape formation prevents normal diagnosis using methods such as ultrasound and CT. These methods give an inaccurate picture when diagnosing a doctor.

Liver hemangioma can be diagnosed using MRI.

Diagnosis in the early stages

Liver hemangioma is quite rare, occurring in approximately 5-7% of the population. Usually this tumor is quite large sizes and rarely exceeds 5-10 cm. It is divided into 3 types: cavernous, capillary and atypical.

• Cavernous hemangiomas look like cavities with a heterogeneous structure and uneven contours. If they begin to grow, they can rupture and cause bleeding.
• Capillary types are practically safe. They are small in size (2-3 cm) and have no tendency to grow; they do not pose a threat.
• In the atypical variant, as the tumor develops, keratinized (hardened) cells appear along its edges.

The hemangioma does not make itself felt for quite a long time. Having small sizes, extensive (weak) growth, showing its symptoms and signs (pain in the right hypochondrium, nausea, etc.) only when it grows to large sizes (and this can happen over several years), we can say that that the only option for diagnosing liver hemangioma is early stages is magnetic resonance imaging (MRI).

Diagnosis at the first symptoms

If the hemangioma has not been previously noticed on comprehensive examination organs of the abdomen, it will manifest itself only when it begins to grow.

Ultrasound of the liver - available method diagnostics

Despite the wide variety of different information content diagnostic methods, liver hemangiomas are always difficult for doctors due to their nonspecific (inherent in many liver diseases) symptoms: enlarged liver, pain in the right hypochondrium, nausea after eating, etc. A patient who consults a doctor with such symptoms is initially offered to undergo an ultrasound, a widespread method available everywhere.

Ultrasound is a non-invasive (without disruption skin) procedure, but since contrast agents are used in the diagnosis of liver diseases, which increase the sensitivity with the information content of this method, it is worth knowing some of the symptoms and side effects that arise from the administration of these substances. When comparing contrast agents for CT, MRI with contrast agents used for contrast ultrasound of the liver, there is less risk allergic reactions, from side effects emit: nausea, dizziness, itching.

Contraindications are: individual intolerance to drugs, failure of any organs, cardiac shunts. It should be noted that not all clinics offer contrast for ultrasound. If an ultrasound reveals a tumor similar to a hemangioma, for differential diagnosis MRI is used, the most informative and highly accurate research method.

Magnetic resonance imaging is a highly effective research method. During the study electromagnetic waves affect the patient. The computer reads the changes and converts them into images made in several projections. The use of contrast during research provides an even more accurate image, that is, deeper grounds for making a correct diagnosis. It is important to know that the study is carried out for about half an hour, during which time the patient cannot move. It is worth noting that the drug is administered on an empty stomach, so before the study it will be necessary not to eat for 6-7 hours.

Contraindications to MRI are:

1. Installed pacemakers.
2. Presence of implants with metal inclusions.
3. Research in patients with mental disorders is questionable.
4. Excess body weight - due to the technical features of the device.
5. First trimester of pregnancy (at later Can).

If these contraindications are present, hemangioma can be diagnosed using a computed tomography scan of the abdomen, but this method has a number of significant disadvantages.

Diagnosis of liver hemangioma using CT

Computed tomography (CT) is also actively used in the diagnosis of this tumor. If the patient cannot afford the MRI method or there are contraindications for this method, the doctor will send the patient for a CT scan. Despite the fact that the study will be performed using contrast, the tomogram cannot always give a complete picture. This is why MRI is preferable when liver hemangioma is suspected.

Computed tomography is a study of the body using a tomograph - a machine with X-ray sensors. However, it has a number of significant contraindications:

A contraindication for computed tomography is an allergy to iodine.

1. Extremely serious condition patient.
2. Pregnancy, lactation.
3. Allergic reactions to iodine (contrast agents contain iodine).
4. Advanced renal and liver failure.
5. Chronic lesions of the thyroid gland.
6. Advanced forms of diabetes mellitus.

Recommended to use computed tomography with contrast, only in case of limited funds and impossibility free diagnostics using MRI, since the method often produces a picture of the study, which is very difficult for a doctor without many additional research differentiate from liver metastases.

The doctor is not sure of the diagnosis, what to do?

As mentioned above, this tumor is difficult to diagnose, so even with the help of an MRI, your doctor may doubt the final diagnosis. In such cases, the doctor suggests instrumental study called a "biopsy".

The study is quite expensive and is performed by puncturing the skin with a special needle under ultrasound control. Material taken from the liver at this study, allows you to always confirm or refute the diagnosis. It is worth noting that this procedure can lead to complications of hemangioma and the development of bleeding, since the tumor is represented by a plexus of blood vessels.

Video

MRI diagnostics or CT diagnostics. Doctor's advice.

This is a round formation with defined contours and a varied echo structure. In the specialized literature, hemangioma is more often described as a formation of increased echogenicity.

Capillary type

a) with a fairly homogeneous, weakly echogenic internal structure and with defined but intermittent contours. Occurs with a well-developed vascular network with the presence of many small cavities;

b) the echostructure is heterogeneous, sometimes the expanded vascular network is clearly visible in the form of echo-negative tracks;

c) the structure is almost echo-negative, with single signals. Characteristic of large blood cavities with the presence of blood clots. A reflection effect is observed behind the dorsal wall of the tumor.

Brain type

The structure of hemangioma is similar to brain tissue, has a small or large nodular structure, of varying echogenicity (rare).

Cavernous type

The structure of hemangioma is of different echogenicity; small round-shaped or large anechoic cavities filled with .

Mixed type

Part of the tumor is anechoic, consisting of large fluid cavities, and part has a nodular structure, that is, echogenic and anechoic large signals alternate. There may be a reflection effect from the rear wall.

In rare cases, hemangiomas can undergo a process of malignization, and echographically this process is almost impossible to differentiate, since there are no specific echographic signs of malignancy in other tumor-like formations, in particular hemangiomas.

Hemangiomas, first of all, should be differentiated from primary hemangiomas, from metastases, nodular hyperplasia, lipoma, etc.; a rather long latent course, good health and good performance liver function, with the help of Doppler it is possible to record the pulsation of the organ, which is not found in other tumors. Angiography helps in the final diagnosis, especially in the presence of large capillary hemangiomas.