Published online Dec 27, 2021. doi: 10.4254/wjh.v13.i12.1892
Peer-review started: February 23, 2021
First decision: May 3, 2021
Revised: May 25, 2021
Accepted: October 24, 2021
Article in press: October 24, 2021
Published online: December 27, 2021
Hepatic hemangioma is usually detected on a routine ultrasound examination because of silent clinical behaviour. The typical ultrasound appearance of hemangioma is easily recognizable and quickly guides the diagnosis without the need for further investigation. But there is also an entire spectrum of atypical and uncommon ultrasound features and our review comes to detail these particular aspects. An atypical aspect in standard ultrasound leads to the continuation of explorations with an imaging investigation with contrast substance [ultrasound/ computed tomography/or magnetic resonance imaging (MRI)]. For a clinician who practices ultrasound and has an ultrasound system in the room, the easiest, fastest, non-invasive and cost-effective method is contrast enhanced ultrasound (CEUS). Approximately 85% of patients are correctly diagnosed with this method and the patient has the correct diagnosis in about 30 min without fear of malignancy and without waiting for a computer tomography (CT)/MRI appointment. In less than 15% of patients CEUS does not provide a conclusive appearance; thus, CT scan or MRI becomes mandatory and liver biopsy is rarely required. The aim of this updated review is to synthesize the typical and atypical ultrasound aspects of hepatic hemangioma in the adult patient and to propose a fast, non-invasive and cost-effective clinical-ultrasound algorithm for the diagnosis of hepatic hemangioma.
Core Tip: Liver hemangiomas are benign tumors usually found on a routine ultrasound in an asymptomatic adult patient. A high-performance ultrasonographic system equipped with contrast-enhanced ultrasound software, allows the experienced examinator to orient the diagnosis quickly, cost-effectively and non-invasively in most cases. This article reviews the typical and atypical ultrasound features of hepatic hemangioma and proposes a diagnostic algorithm for liver hemangiomas in patients referred to the hepatologist.