Differential diagnosis of hepatomegaly in children. A rare pediatric case: Infantile multifocal hepatic hemangioma. Case report
- Authors: Goryainova A.N.1, Osmanov I.M.2,3, Maykova I.D.3, Kolomina I.G.3, Lavrova T.R.3, Lukankina L.N.4, Bukin S.S.3, Goncharova L.V.3, Elfimova O.I.3, Koroid N.V.3, Kuzina N.E.3, Riapolova I.A.3
-
Affiliations:
- Russian Medical Academy of Continuous Professional Education
- Pirogov Russian National Research Medical University
- Bashlyaeva Children’s City Clinical Hospital
- Voronezh Regional Children’s Clinical Hospital No. 1
- Issue: No 4 (2024)
- Pages: 404-410
- Section: Articles
- URL: https://pediatria.orscience.ru/2658-6630/article/view/642106
- DOI: https://doi.org/10.26442/26586630.2024.4.203063
- ID: 642106
Cite item
Full Text
Abstract
Hepatomegaly is one of the most common symptoms in children. Liver enlargement can be observed in any infectious and non-infectious inflammatory disease, be an early clinical sign of acute leukemia, systemic connective tissue disease, liver neoplasms, congenital metabolic disorders, circulatory and respiratory failure, helminthiases, toxic effects of drugs, abnormalities of the biliary tract, etc. In the vast majority of cases, the simple examination methods that have long become routine in pediatrician practice help to identify the cause of hepatomegaly: abdominal ultrasound, complete blood count, and blood chemistry. The article presents a rare case of infantile multifocal hepatic hemangioma in a girl in early infancy, which required a long diagnostic search involving various specialists.
Full Text

About the authors
Aleksandra N. Goryainova
Russian Medical Academy of Continuous Professional Education
Author for correspondence.
Email: alex.goriaynowa@yandex.ru
ORCID iD: 0009-0009-9339-4152
Cand. Sci. (Med.)
Russian Federation, MoscowIsmail M. Osmanov
Pirogov Russian National Research Medical University; Bashlyaeva Children’s City Clinical Hospital
Email: alex.goriaynowa@yandex.ru
ORCID iD: 0000-0003-3181-9601
D. Sci. (Med.), Prof.
Russian Federation, Moscow; MoscowIrina D. Maykova
Bashlyaeva Children’s City Clinical Hospital
Email: alex.goriaynowa@yandex.ru
ORCID iD: 0000-0003-2700-2607
Cand. Sci. (Med.)
Russian Federation, MoscowIrina G. Kolomina
Bashlyaeva Children’s City Clinical Hospital
Email: alex.goriaynowa@yandex.ru
Head of Endocrinology Department
Russian Federation, MoscowTatiana R. Lavrova
Bashlyaeva Children’s City Clinical Hospital
Email: alex.goriaynowa@yandex.ru
Head of Ultrasound Diagnostics Department
Russian Federation, MoscowLarisa N. Lukankina
Voronezh Regional Children’s Clinical Hospital No. 1
Email: alex.goriaynowa@yandex.ru
Cand (Sci.) Med.
Russian Federation, VoronezhSergei S. Bukin
Bashlyaeva Children’s City Clinical Hospital
Email: alex.goriaynowa@yandex.ru
endocrinologyst
Russian Federation, MoscowLudmila V. Goncharova
Bashlyaeva Children’s City Clinical Hospital
Email: alex.goriaynowa@yandex.ru
gastroenterologist
Russian Federation, MoscowOlga I. Elfimova
Bashlyaeva Children’s City Clinical Hospital
Email: alex.goriaynowa@yandex.ru
pediatrician
Russian Federation, MoscowNatalia V. Koroid
Bashlyaeva Children’s City Clinical Hospital
Email: alex.goriaynowa@yandex.ru
Head of the Infectious Diseases Department No. 3
Russian Federation, MoscowNatalia E. Kuzina
Bashlyaeva Children’s City Clinical Hospital
Email: alex.goriaynowa@yandex.ru
pediatrician
Russian Federation, MoscowIuliia A. Riapolova
Bashlyaeva Children’s City Clinical Hospital
Email: alex.goriaynowa@yandex.ru
pediatrician
Russian Federation, MoscowReferences
- Тур А.Ф. Пропедевтика детских болезней. М.: МЕДГИЗ, 1955. 363 с. [Tur AF. Propedevtika detskikh boleznei. Moscow: MEDGIZ, 1955. 363 p. (in Russian)].
- Камышников В.С. Норма в лабораторной медицине: справочник. М.: МЕДпресс-информ, 2014. 334 с. [Kamyshnikov VS. Norma v laboratornoi meditsine: spravochnik. Moscow: MEDpress-inform, 2014. 334 p. (in Russian)].
- Пыков М.И. Детская ультразвуковая диагностика. Учебник в 2 т. Т. 1. Гастроэнтерология. М.: Видар-М, 2014. 256 с. [Pykov MI. Detskaia ultrazvukovaia diagnostika. In 2 vol. Vol. 1. Gastroenterologiia. Moscow: Vidar-M, 2014. 256 p. (in Russian)].
- Kim S, Kim M-J, Lee M-J, et al. Ultrasonographic findings of type IIIa biliary atresia. Ultrasonography. 2014;33(4):267-74. doi: 10.14366/usg.14016
- Lee S, Cheon J-E, Choi Y, et al. Ultrasonographic Diagnosis of Biliary Atresia Based on a Decision-Making Tree Model. Korean J Radiol. 2015;16(6):1364-72. doi: 10.3348/kjr.2015.16.6.1364
- Шерлок Ш., Дули Дж. Заболевания печени и желчных путей. Пер с англ. М.: ГЭОТАР, 1999. 860 с. [Sherlok Sh, Duli Dzh. Zabolevaniia pecheni i zhelchnykh putei. Moscow: GEOTAR, 1999. 860 p. (in Russian)].
- Shabbir Z, Javaid A, Din IU. Infantile Hepatic Hemangioma. J Pak Med Assoc. 2018;68(12):1846-7.
- Kanada KN, Merin MR, Munden A, et al. A prospective study of cutaneous findings in newborns in the United States: correlation with race, ethnicity, and gestational status using updated classification and nomenclature. J Pediatr. 2012;161:240-5. doi: 10.1016/j.jpeds.2012.02.052
- Подкаменев А.В., Сырцова А.Р., Ти Р.А., и др. Гигантские гемангиомы печени у новорожденных: краткий литературный обзор с описанием двух клинических случаев. Педиатр. 2020;11(5):57-65 [Podkamenev AV, Syrtsova AR, Ti RA, et al. Gigantskie gemangiomy pecheni u novorozhdennykh: kratkii literaturnyi obzor s opisaniem dvukh klinicheskikh sluchaev. Pediatr. 2020;11(5):57-65 (in Russian)]. doi: 10.17816/PED11557-65
- Chen XD, Ma G, Chen H, et al. Maternal and perinatal risk factors for infantile hemangioma: A case-control study. Pediatr Dermatol. 2013;30:457-61. doi: 10.1111/pde.12042
- Drolet BA, Esterly NB, Frieden IJ. Hemangiomas in children. New Engl J Med. 1999;341:173-81. doi: 10.1056/NEJM199907153410307
- Ji Y, Chen S, Xiang B, et al. Clinical features and management of multifocal hepatic hemangiomas in children: a retrospective study. Sci Rep. 2016;6:31744. doi: 10.1038/srep31744
- Ozdemir LC, Kar YD, Sohret NC, et al. Beta blocker and steroid therapy in the treatment of infantile hepatic hemangioendothelioma. Drug Discoveries & Therapeutics. 2017;11(3):161-4. doi: 10.5582/ddt.2017.01025
- Петрушин А.В., Мыльников А.А., Гарбузов Р.В., и др. Алгоритм диагностики и выбор методов лечения различных форм гемангиом печени у детей. Вопросы гематологии/онкологии и иммунопатологии в педиатрии. 2017;16(1):22-7 [Petrushin AV, Mylnikov AA, Garbuzov RV, et al. Diagnostic procedure and choice of treatment of various forms of liver hemangiomas in children. Pediatric Hematology/Oncology and Immunopathology. 2017;16(1):22-7 (in Russian)]. doi: 10.24287/1726-1708-2017-16-1-22-27
- Campbell V, Beckett R, Adid N, Hoey S. Resolution of Consumptive Hypothyroidism Secondary to Infantile Hepatic Hemangiomatosis with a Combination of Propranolol and Levothyroxine. J Clin Res Pediatr Endocrinol. 2018;10(3):294-8. doi: 10.4274/jcrpe.4865
- Zhang Z, Chen H-J, Yang WJ, et al. Infantile hepatic hemangioendothelioma: A clinicopathologic study in a Chinese population. World J Gastroenterol. 2010;16(36):4549-57. doi: 10.3748/wjg.v16.i36.4549
- Huang SA, Tu HM, Harney JW, et al. Severe hypothyroidism caused by type 3 iodothyronine deiodinase in infantile hemangiomas. N Eng J Med. 2000;343:185-9. doi: 10.1056/NEJM200007203430305
- Huang SA, Fish SA, Dorfman DM, et al. A 21-year-old woman with consumptive hypothyroidism due to a vascular tumor expressing type 3 iodothyronine deiodinase. J Clin Endocrinol Metab. 2002;87:4457-61. doi: 10.1210/jc.2002-020627
- Yeh I, Bruckner A, Sanchez R, et al. Diffuse infantile hepatic hemangiomas: a report of four cases successfully managed with medical therapy. Pediatr Dermatol. 2011;28:267-75. doi: 10.1111/j.1525-1470.2011.01421.x
- Fisher DA. Clinical review 19: Management of congenital hypothyroidism. J Clin Endocr Metab. 1991;72:523-9. doi: 10.1210/jcem-72-3-523
- Bessho K, Etani Y, Ichimori H, et al. Increased type 3 iodothyronine deiodinase activity in a regrown hepatic hemangioma with consumptive hypothyroidism. Eur J Pediatr. 2010;169:215-21. doi: 10.1007/s00431-009-1009-x
- Cho YH, Taplin C, Mansour A, et al. Case report: consumptive hypothyroidism consequent to multiple infantile hepatic hemangiomas. Curr Opin in Pediatr. 2008;20:213-5. doi: 10.1097/MOP.0b013e3282f409c3
- Léauté-Labrèze C, Dumas de la Roque E, Hubiche T, et al. Propranolol for severe hemangiomas of infancy. N Engl J Med. 2008;358(24):2649-51. doi: 10.1056/NEJMc0708819
- Torres E, Rosa J, Leaute-Labreze C, Soares-de-Almeida L. Multifocal infantile haemangioma: a diagnostic challenge. BMJ Case Rep. 2016:bcr2016214827. doi: 10.1136/bcr-2016-214827
- Tsai M-C, Liu H-C, Yeung C-Y. Efficacy of infantile hepatic hemangioma with propranolol treatment. A case report. Medicine. 2019;98(4):e14078. doi: 10.1097/MD.0000000000014078
Supplementary files
