How to choose the hemangioma treatment modality?

Hepatic hemangiomas, also known as hepatic hemangiomas and intrahepatic hemangiomas, are common benign tumors of the liver associated with congenital developmental abnormalities and are divided into cavernous hemangiomas, sclerosing hemangiomas, vascular endothelial cell tumors and capillary hemangiomas. The most common type of hemangioma is cavernous hemangioma. In terms of size, number and location, they can be divided into small hepatic hemangiomas and giant hepatic hemangiomas; single hepatic hemangioma and multiple hepatic hemangiomas; left lobe hemangioma and right lobe hemangioma. What we generally refer to as hepatic hemangioma is cavernous hemangioma. It can occur at any age, but most hepatic hemangiomas are found in adults and are more common in women than men between the ages of 30 and 60. They vary in size and can occupy the entire abdominal cavity in large cases. Most of them are smaller than 4 cm and are often multiple. They can occur in both the left and right lobes of the liver, with the right lobe being more common. The tumor may appear in any part of the liver and is often located under the peritoneum, with a diameter of less than 4 cm, but may be as small as a few mm or as large as 30 cm. Sometimes thrombosis and scarring can be seen within the hemangioma, and occasionally calcification. Microscopically, hemangioma is a network of empty spaces lined with flattened endothelial cells of different sizes, containing red blood cells, and sometimes fresh mechanized thrombi. The tumor is clearly demarcated from the surrounding tissue. Clinical manifestations: most of the tumors less than 4 cm are asymptomatic and are often found by chance during physical examination with abdominal ultrasound; about 40% of the tumors above 4 cm are associated with abdominal discomfort, hepatomegaly, loss of appetite, dyspepsia and other symptoms. Hepatic hemangioma often contains mechanized thrombus which may cause swelling of the tumor due to repeated thrombosis, resulting in distension of Glisson′s envelope. The masses vary in softness and firmness, with varying degrees of compressibility, and a few are firm and nodular. The masses rarely rupture spontaneously. Liver function is generally normal. The rare syndromes of large hemangiomas are consumptive coagulation disorder, thrombocytopenia and hypofibrinemia. The following is the minimally invasive treatment model of a case of giant hemangioma in our department, which we would like to share with you. 1.Interventional embolization: before embolization and after embolization 2.Radiofrequency ablation