Jeﬀ T. Counters, DO, MPH
Heather J. Chial, MD, MSc
Gundersen Health System
La Crosse, WI
60 year old female
Recent hospitalizaHon for management of
bleeding from hepaHc hemangiomas
Chemical and coil embolizaHons
Superior right hepaHc artery and the right hepaHc
Composed of cavernous vascular spaces
Most common benign mesenchymal hepaHc
Prevalence ranges from 0.4-‐20%
More frequent in women (3:1 raHo)
Wide range of size (millimeters to > 20 cm)
Usually solitary but can be mulHple
Usually an incidental ﬁnding
SomeHmes may have abdominal pain, RUQ
Usually simple observaHon
If giant hemangiomas radiologic follow-‐up
ProphylacHc resecHon not advised due to
Surgical/intervenHonal management only if
Lytes: Na 120, K 4.0, Cl 83, CO2 30
Serum Osmol 265
Renal FuncHon: BUN 18, Cr 0.85
Liver: Bili 2.8, AST 59, ALT 39, Alk Phos 281
Coag: INR 1.4
Gallbladder sludge and cholelithiasis
ParHal compression of IVC
Caused by compression of the inferior vena
Syndrome is characterized by:
Anasarca below the level of the diaphragm
Shortness of breath
Increased risk for infecHon and thrombosis.
Most common cause: Thrombosis
1 Case report of Post-‐traumaHc biloma
No reports of hepaHc hemangiomas
Other lesser reported causes
Case reports and retrospecHve reviews of IVC
ReducHon in body weight
Increase in urine volume
Improvement of lower extremity edema
Improvement abdominal distension and ascites
Improved breathing, eaHng, and mobility
Transferred to outside facility for IVC stenHng
Successful in paHents with IVC syndrome
associated with hepaHc neoplasms.
Unfortunately, the paHent died from
Special Thank you to Dr. Todd Ebbert for assistance with image selecHon
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