A72-09 Enormous Hepatic Hemangioma in a Patient With Cardiomyopathy: A Case of Conservative Management of a Clinically Silent Lesion

Introduction Hepatic hemangiomas (HH) are the most common benign liver tumors, composed of vascularspaces lined by endothelial cells and supplied by the hepatic artery (1). Most are asymptomaticand incidentally discovered, but giant hemangiomas (>10 cm) may cause mass effect, rupture,or high-output cardiac failure (2). Their clinical relevance increases in patients withcardiomyopathy, where altered hemodynamics and bleeding risk complicate management.While surgery is reserved for symptomatic, enlarging, or diagnostically uncertain lesions,conservative observation remains standard for stable cases (3). We report a 61-year-old manwith non-ischemic cardiomyopathy and an enormous hepatic hemangioma, emphasizingaccurate imaging, multidisciplinary evaluation, and non-invasive management of large butclinically silent hepatic hemangiomas. Case Presentation A 61-year-old man with stable non-ischemic cardiomyopathy (LVEF 40–45%) presented with a4-month history of unintentional 5-lb weight loss with no abdominal pain, jaundice, orgastrointestinal symptoms. He denied alcohol or tobacco use and remained physically active.Physical examination revealed a thin habitus (BMI 18 kg/m²) with a markedly enlarged, non-tender liver extending to the pelvis but no ascites or stigmata of chronic liver disease.Laboratory studies showed normal liver function and tumor markers (AFP, CEA, CA 19-9), andnegative viral hepatitis serologies. Non-contrast chest CT incidentally revealed a right hepaticmass measuring 16 cm. MRI with contrast confirmed a 24.5 × 16.7 × 12.6 cm lesion with classicenhancement features and multiple smaller hemangiomas in the left lobe. The multidisciplinaryliver tumor board recommended conservative monitoring with serial imaging.Discussion :Hepatic hemangioma (HH) is the most common benign liver tumor, often discovered incidentallyduring imaging for unrelated reasons. Giant HHs (>10 cm) are rare and may cause mass effect,rupture, or Kasabach-Merritt syndrome (4). In this patient, the presentation with isolated weightloss, stable cardiomyopathy, and an enormous 25-cm lesion is unusual. MRI remains thediagnostic modality of choice, with a reported sensitivity and specificity of 98% and 99%,respectively. Despite its size, the lesion’s classic imaging pattern supported conservativemanagement. A multidisciplinary team involving hepatology, cardiology, radiology, and surgeryrecommended close surveillance given preserved function and lack of symptoms. This casehighlights individualized, non-invasive management and the importance of aligning radiologiccertainty with patient-centered decision-making (5,6). Conclusion This case illustrates that even enormous hepatic hemangiomas can remain asymptomatic,particularly in patients with cardiac comorbidities. Accurate MRI-based diagnosis,multidisciplinary evaluation, and conservative management with regular imaging and counselingrepresent the safest approach, emphasizing long-term hepatic and cardiovascular surveillanceto prevent potential complications. This abstract is funded by: None