Many patients come to me anxiously in the clinic and say, “Doctor, please take a look, the other day I had a physical examination and found an occupancy in my liver. Hepatic hemangioma, what is it? Is it very scary? Let Professor Sun Xing of the Department of General Surgery of Shanghai First People’s Hospital answer you one by one. I. What is hepatic hemangioma? Hepatic hemangioma, hepatic adenoma and focal nodular hyperplasia of the liver (FNH) are the three common benign tumors of the liver. Among them, hemangioma is the most prevalent benign liver tumor. Hepatic hemangiomas can occur at any age, but are more common in women than in men between the ages of 30 and 50, with approximately equal incidence in the left and right liver. When the tumor is small, there is no clinical symptom, and most of them are found by chance during physical examination. The tumor grows slowly and is mostly solitary, and the course of the disease can last for several years or even be asymptomatic for life without being detected. What are the symptoms of hemangioma? Generally speaking, there is no symptom when the hemangioma is relatively small. When the hemangioma increases to more than 125px, the following symptoms may appear: 1. abdominal mass: abdominal mass with cystic feeling, no pressure pain, smooth surface. 2. 2. Compression symptoms: Huge hemangioma may push and compress the surrounding tissues and organs. It can have the following manifestations: difficulty in swallowing, jaundice, splenomegaly and ascites; it can also can have gastrointestinal symptoms, such as right upper abdominal discomfort, abdominal distension, belching and abdominal pain. You can compare it with your own symptoms. 3.Ruptured hepatic hemangioma bleeding: ruptured hepatic hemangioma bleeding can appear with severe pain in the upper abdomen, as well as bleeding and shock symptoms. Most of the hepatic hemangiomas rupture and bleed due to external force. 4.Kasabach-Merritt syndrome: coagulation abnormalities caused by thrombocytopenia and large consumption of coagulation factors. The pathogenesis of Kasabach-Merritt syndrome is the retention of blood in the giant hemangioma, which consumes a large amount of red blood cells, platelets, coagulation factors II, V, VI and fibrinogen, causing abnormal coagulation mechanism, which may further develop into DIC. 5.Other symptoms: When a hemangioma with a tipped hemangioma growing outside the liver is twisted, necrosis may occur and severe abdominal pain, fever and deficiency may appear. Individual patients with huge hemangioma accompanied by arteriovenous fistula formation may have increased return blood volume, leading to heart failure. Physical examination: The abdominal mass is connected to the liver, with smooth surface, soft texture, cystic sensation and different degrees of compression. IV. What tests can be chosen? When there is a suspicion of hemangioma, what examinations should we perform? The following tests are for your reference: 1. Ultrasound examination (recommended) of hepatic hemangioma is hyperechoic, and those with hypoechogenicity have sieve structure, uniform density, regular shape and clear boundary. Larger hemangiomas may be lobulated in cross-section, and the internal echogenicity is still mainly enhanced. They may appear as a tubular network or irregular nodular or lumpy hypoechoic areas, and sometimes they may also appear calcified hyperechoic and posterior acoustic shadow, which is caused by thrombus formation, mechanization or calcification in the lumen of blood vessels. 2.Contrast ultrasound can be considered selectively for cases of hepatic hemangioma with atypical imaging performance. Typical hemangioma ultrasonography shows nodular or circumferential enhancement in the periphery in the arterial phase, which gradually expands to the center with time. 3.CT examination (recommended) CT scan examination shows a well-defined round or round-like low-density lesion in the liver parenchyma, and a few may be irregular in shape. 4.MRI examination (recommended) MRI examination shows low signal in T1-weighted and high signal in T2-weighted, with uniform intensity and clear edges, and contrast with the surrounding liver, which is described as “light bulb sign”. 5. Other tests such as liver biopsy, hepatic arteriography, PET/CT, etc. Liver biopsy has low accuracy and can lead to bleeding; hepatic arteriography is an invasive test and is not necessary; whole-body positron emission computed tomography (PET/CT) is valuable to exclude metabolically active malignant tumors.