Management of a Giant Haemangioma of the Caudate Lobe of the Liver

Introduction: Hepatic haemangiomas are usually asymptomatic benign liver tumors, without malignant potential. Giant hepatic haemagiomas (GHH) are defined as having a an overall diameter of >0035cm are more likely to be symptomatic. Caudate lobe hemangiomas are relatively rare. However, due to their unique anatomical location, pose a surgical challenge when further intervention is required. Method: We herein present a case of a 58-year-old female patient managed in our center for a caudate lobe GHH. Results: The patient presented with an eight years history of asymptomatic, incidentally discovered caudate lobe GHH. The lesion was first discovered via ultrasound during routine screening. Cross-sectional imaging with CT and MRI confirmed the presence of a 4.5cm caudate haemangioma, compressing the inferior vena cava. However, she was lost to follow up. Seven years later, following a fall, the patient visited the emergency department where a remarkable increase in size (8.7x7x6cm) was noted in CT imaging. Persistent radiographic evidence of IVC compression was again noted without any clinical manifestations. Following individualized thorough planning of the therapeutic approach, further preoperative trans-arterial embolism followed by surgical intervention was decided, and an open caudate lobectomy with left-lateral approach was performed in combination with left posterolateral hepatectomy. Postoperative pathological findings revealed a cavernous hemangioma. Her postoperative course was uneventful and was discharged on the eighth postoperative day. Conclusion: The individualized therapeutic approach in patients with caudate liver haemangiomas is challenging, despite their benign nature, due to their anatomical specificity and possible combination of therapeutic options.