Infantile hepatic hemangioma (IHH) can be diagnosed on a single phased portal venous CT when they demonstrate all of the typical enhancement features (peripheral, nodular, and discontinuous enhancement).

They require close monitoring with serial ultrasounds and generally do not require specific intervention and only needing supportive treatment focussing on the complications.

In asymptomatic patients treatment is not required and follow up is usually reserved for HH of more than 5 cm in diameter at 6-12 months to asses for rapid growth with the same imaging test used at diagnosis.

For the patients who required therapy, the presence or absence of a shunt on either sonography or angiography was an independent predictor of the inability of medical therapy to control symptoms. Patients with a shunt (arteriovenous, arterioportal, or portal venous fistula) are more likely to require embolization or surgery than those without shunts. Therefore, imaging findings appear to have a major role in predicting the need for nonpharmacologic therapy such as embolization. The presence of a shunt could be easily missed in patients who are not explored angiographic or with Doppler ultrasound. These lesions should be closely followed by an interprofessional team consisting of a pediatrician or nurse practitioner, with a pediatric hematologist/oncologist, with serial imaging and close monitoring for complications.

Limitations:  Infantile hepatic hemangioendothelioma represents approximately 1% of all childhood tumors, thus there is a limitation on population studies [7].

None of the patients were imaged with gadolinium-enhanced MRI, a technique that provides the most accurate diagnosis.