Das kavernöse Leberhämangiom: Rationale Diagnostik und therapeutisches Vorgehen

Zusammenfassung

Das Leberhämangiom ist weltweit der häufigste Lebertumor. Aufgrund der hohen Inzidenz ist der Krankheitswert zweifelhaft und die Frage der Therapienotwendigkeit zu diskutieren. Das klinische Krankheitsbild ist uncharakteristisch und häufig nicht eindeutig zuzuordnen. Spontanrupturen sind äußerst selten. Neben Sonographie als Primärdiagnostik stehen heute die Kontrastmittel-CT sowie die Magnetresonanztomographie im Vordergrund. Szintigraphie und Angiographie werden bei unklaren Befunden hinzugezogen. Mit bildgebenden Verfahren ist ein Hämangiom in über 95 % der Fälle sicher zu diagnostizieren. Nur bei unklaren Fällen sollte eine Explorativlaparoskopie oder -tomie mit Histologiesicherung vorgenommen werden. Eine transkutane Blindpunktion ist bei Hämangiomverdacht kontraindiziert. Außer in Fällen diagnostischer Unsicherheit besteht eine Operationsindikation heute nur noch bei komplizierenden Verläufen mit Kompressionserscheinungen, raschem Wachstum oder individuellen Besonderheiten. Das Management der Spontanruptur besteht im Allgemeinen in der primären Embolisation gefolgt von elektiver Operation.

Abstract

Hemangiomas are the most common benign liver tumours. Due to the high incidence the pathological value of this tumour is doubtful and the necessity for specific treatment requires further discussion. Spontaneous ruptures of liverhemangiomas are exceptional. Using modern imaging procedures, hemangiomas of the liver can be diagnosed safely in more than 95 %. Ultrasound is the first line diagnostic means followed by CT scan and MRI imaging. Only in cases of diagnostic uncertainties, an explorative laparoscopy or laparotomy should be considered in order to obtain a histological diagnosis. Transcutaneous biopsies are contraindicated in suspected hemangiomas. An indication for surgical treatment is only given in cases of diagnostic uncertainties, in rapidly growing tumors or in complicated cases, e. g. compression of vessels or viscera. A ruptured hemangioma can be treated by embolization and subsequent surgery in many, but not all cases.

Leberhämangiom - Diagnostik - Therapiekonzept - kavernös - Operationsindikation - Enukleation

Liver hemangioma - diagnostic management - therapeutical concepts - cavernous - indication for surgery - enucleation

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