Hepatic hemangiomatosis of neonatal onset

Infantile hemangioma is the most frequent pediatric benign tumor. The involvement is usually cutaneous, but it can be visceral too. Some presentations pose a diagnostic challenge and can even be life-threatening. We present two cases that consulted to our center. The first is a 13-day-old female newborn, who presents with an increase in the number and size of erythematous micromacules-papules, which she already had. She is diagnosed with infantile hemangiomatosis. In the extension study, the abdominal ultrasound shows multiple hepatic hemangiomas. The evolution is favorable without treatment, disappearing almost all hemangiomas within the first year. The second case is a 37-day-old infant, who presents with propulsive vomiting and abdominal distention. The physical exam is remarkable for cutaneous jaundice and 4cm hepatomegaly. Blood tests show cholestatic hepatitis without liver failure and hypothyroidism. Abdominal ultrasound shows diffuse hepatic hemangiomatosis, which is confirmed by MRI. Oral Propanolol and Levothyroxine are started. The evolution is favorable, with resolution of the hemangiomatosis.

Hemangiomas are usually cutaneous but visceral involvement must be studied in the presence of more than 5 cutaneous hemangiomas or if they are large. Hepatic hemangiomas are the most common. They can be congenital (focal), which can involute spontaneously, or infantile (multifocal or diffuse), which can produce symptoms (cholestasis, hepatomegaly, heart failure, hypothyroidism…). The treatment is Propranolol and, in case of hypothyroidism, Levothyroxine. To conclude, we emphasize the importance of early diagnosis of hepatic hemangiomatosis because it has the possibility of specific and effective treatment.