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A Case of Giant Hemangioma of the Liver Presenting with Fever and Cough

발열과 기침으로 발현된 거대 간 혈관종의 1예

  • Lee, Seo Hui (Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Yoon, Ji Hyun (Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Cheon, Jaeyoung (Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Jo, Se Hee (Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Kim, Kihyun (Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Jin, Sung Joon (Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Song, Young Goo (Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine)
  • 서희 (연세대학교 의과대학 강남세브란스병원 내과) ;
  • 윤지현 (연세대학교 의과대학 강남세브란스병원 내과) ;
  • 천재영 (연세대학교 의과대학 강남세브란스병원 내과) ;
  • 조세희 (연세대학교 의과대학 강남세브란스병원 내과) ;
  • 김기현 (연세대학교 의과대학 강남세브란스병원 내과) ;
  • 진성준 (연세대학교 의과대학 강남세브란스병원 내과) ;
  • 송영구 (연세대학교 의과대학 강남세브란스병원 내과)
  • Received : 2013.07.16
  • Accepted : 2013.12.09
  • Published : 2014.10.01

Abstract

Hemangioma of the liver is usually asymptomatic and incidentally discovered. However, giant hemangioma of the liver may be symptomatic, which is an indication for treatment. A 31-year-old female was admitted with a fever and 1-month history of a non-productive cough. Her blood test results revealed thrombocytopenia, anemia, and mild coagulopathy. A giant hemangioma of the liver was the cause of her symptoms and signs, and was too large for surgical treatment. Therefore, we performed two sessions of transcatheter hepatic arterial embolization (TAE). The patient has been doing well without fever for 1 year following the second TAE procedure. Surgical resection and enucleation are the traditional treatments of choice for symptomatic giant hemangioma of the liver. However, the signs and symptoms of giant hemangioma of the liver improved by TAE in the present case. We herein report a case of complicated giant hemangioma of the liver that was partially treated by TAE and conservative management.

간 혈관종은 주로 무증상이고 우연히 발견되는 경우가 많다. 그러나 거대 간 혈관종은 증상을 야기시킬 수 있으며 이 경우 치료가 필요하다. 이 증례는 한 달 동안 지속된 발열과 기침으로 내원한 31세 여환에서 거대 간 혈관종을 진단한 경우이다. 내원 당시 혈액 검사상 빈혈, 경미한 응고장애, 혈소판 감소증 소견이 보였다. 수술을 고려하기에는 크기가 너무 컸기 때문에 경피적 간 동맥 색전술을 두 차례 시행하였고, 그 후 1년 동안 추적관찰 중에도 증상 조절 중이다. 일반적으로 증상이 있는 거대 간 혈관종은 수술적 치료를 해야 하는 것으로 여겨지고 있으며 경피적 간 동맥 색전술에 대한 장기적 예후 및 효과에 대해서는 보고된 것은 없다. 본 증례에서는 최소 침습적 치료인 경피적 간 동맥 색전술로 거대 간 혈관종으로 인한 증상을 효과적으로 치료할 수 있었으며, 현재까지 증상 조절 중으로 이를 문헌고찰과 함께 보고하는 바이다.

Keywords

References

  1. Lee CW, Chung YH, Lee GC, Kim JY, Lee JS. A case of giant hemangioma of the liver presenting with fever of unknown origin. J Korean Med Sci 1994;9:200-204. https://doi.org/10.3346/jkms.1994.9.2.200
  2. Lerner SM, Hiatt JR, Salamandra J, et al. Giant cavernous liver hemangiomas: effect of operative approach on outcome. Arch Surg 2004;139:818-821. https://doi.org/10.1001/archsurg.139.8.818
  3. Coumbaras M, Wendum D, Monnier-Cholley L, Dahan H, Tubiana JM, Arrive L. CT and MR imaging features of pathologically proven atypical giant hemangiomas of the liver. AJR Am J Roentgenol 2002;179:1457-1463. https://doi.org/10.2214/ajr.179.6.1791457
  4. Pateron D, Babany G, Belghiti J, et al. Giant hemangioma of the liver with pain, fever, and abnormal liver tests: report of two cases. Dig Dis Sci 1991;36:524-527. https://doi.org/10.1007/BF01298887
  5. Pol B, Disdier P, Le Treut YP, Campan P, Hardwigsen J, Weiller PJ. Inflammatory process complicating giant hemangioma of the liver: report of three cases. Liver Transpl Surg 1998;4:204-207. https://doi.org/10.1002/lt.500040306
  6. Kasabach HH, Merritt KK. Capillary hemangioma with extensive purpura: report of a case. Am J Dis Child 1940;59:1063-1070. https://doi.org/10.1001/archpedi.1940.01990160135009
  7. Aslan A, Meyer Zu Vilsendorf A, Kleine M, Bredt M, Bektas H. Adult Kasabach-Merritt syndrome due to hepatic giant hemangioma. Case Rep Gastroenterol 2009;3:306-312. https://doi.org/10.1159/000242420
  8. Shellenberger MJ, Smith R, Varma C, Kotru A, Maloo M, Gerst H. Hepatectomy cures a cough: giant cavernous hemangioma in a patient with persistent cough. J Am Osteopath Assoc 2010;110:675-677.
  9. Ochsner JL, Halpert B. Cavernous hemangioma of the liver. Surgery 1958;43:577-582.
  10. Reading NG, Forbes A, Nunnerley HB, Williams R. Hepatic haemangioma: a critical review of diagnosis and management. Q J Med 1988;67:431-445.