Massive hepatic hemangioma complicated by Kasabach-Merritt syndrome
Images in Clinical Medicine

Massive hepatic hemangioma complicated by Kasabach-Merritt syndrome

Xixi Gao, Jia Huang, Zhiying Yang

Department of Hepatobiliary Surgery, China-Japan Friendship Hospital, Beijing, China

Correspondence to: Zhiying Yang, MD; Jia Huang, MD. Department of Hepatobiliary Surgery, China-Japan Friendship Hospital, No. 2 Yinghua East Street, Chaoyang District, Beijing 100029, China. Email: yangzhy@aliyun.com; Huangjia20033218@aliyun.com.

Submitted Jul 30, 2025. Accepted for publication May 18, 2026. Published online Jun 12, 2026.

doi: 10.21037/hbsn-2025-557

A 22-year-old male with a giant hepatic hemangioma (15 cm × 16.6 cm in 2020) developed progressive abdominal distension in May 2024. Computed tomography (CT) revealed tumor enlargement to 29 cm × 34.6 cm. Transarterial embolization (TAE) in July 2024 paradoxically accelerated tumor growth. By November 2024, the hemangioma reached nearly 50 cm, causing orthopnea and inability to lie flat (Figure 1). Laboratory findings confirmed Kasabach-Merritt syndrome (KMS): platelets 92×109/L, prothrombin time (PT) 23 s, fibrinogen 0.6 g/L, D-dimer >20 mg/L, and decreased extrinsic pathway factors (II 46%, V 43%, VII 47%, X 51%). Preoperative and postoperative laboratory data are shown in Table 1. Preoperative volumetry showed total liver volume 21,105 cm³, tumor volume 18,961 cm³, future liver remnant >30% of standard liver volume. On December 16, 2024, the patient underwent successful right trisectionectomy (Figure 2). Histopathology confirmed cavernous hemangioma (Figure 3). Postoperative recovery was uneventful, KMS resolved completely, with platelet, PT, and fibrinogen normalizing by discharge on postoperative day 9. At 12-month follow-up, the patient was asymptomatic and had resumed normal activities. CT showed stable residual small hemangiomas in the left lobe and a resolved sterile fluid collection (sterile biloma/seroma) at the resection margin (Figure 4). This case demonstrates that ultra-giant hepatic hemangioma with adult-onset KMS can be safely resected, and TAE may paradoxically accelerate tumor progression.

Figure 1 Preoperative contrast-enhanced CT showing the nearly 50 cm hemangioma compressing the left lobe and inferior vena cava. CT, computed tomography.

Table 1

Comparison of preoperative and postoperative laboratory data before and after right trisectionectomy

Index Normal range Preoperative Postoperative (3 days) Postoperative (7 days) Postoperative (3 months) Postoperative
(6 months)
WBC (×109/L) 4.0–10.0 1.54 7.39 6.86 4.89 6.13
HGB (g/L) 120–160 75 149 143 140 156
PLT (×109/L) 100–300 96 97 196 193 208
PT (s) 11–15 25 15.7 16.2 – 14.3
INR 0.85–1.5 2.19 1.24 1.29 – 1.10
APTT (s) 28.0–43.5 52.6 44.0 42.9 – 35.9
Fib (g/L) 2.0–4.0 0.6 3.56 2.73 – 3.19
D-dimer (mg/L) 0–0.5 >20 12.84 7.65 – 1.65
Tbil (μmol/L) ≤23.0 41.84 56.80 39.54 19.58 16.75
Dbil (μmol/L) ≤8 9.58 20.49 12.29 2.63 3.66

APTT, activated partial thromboplastin time; Dbil, direct bilirubin; Fib, fibrinogen; HGB, hemoglobin; INR, international normalized ratio; PLT, platelet; PT, prothrombin time; WBC, white blood cell; Tbil, total bilirubin.

Figure 2 Intraoperative photograph during right trisectionectomy.
Figure 3 Histopathological image (hematoxylin and eosin stain, ×100) of the resected specimen showing large, thin‑walled, blood‑filled vascular spaces lined by a single layer of flattened endothelium, confirming hepatic cavernous hemangioma. No mitotic figures or atypical endothelial cells are seen.
Figure 4 Postoperative follow-up abdominal CT images. From top to bottom: contrast-enhanced CT at 2 months, non-contrast CT at 6 months, and non‑contrast CT at 8 months after surgery. The images demonstrate stable residual small hemangiomas in the left lateral section without interval growth, and a low-density encapsulated fluid collection at the resection margin (sterile biloma that resolved after percutaneous drainage). CT, computed tomography.

Acknowledgments

None.

Footnote

Provenance and Peer Review: This article was a standard submission to the journal. The article has undergone external peer review.

Peer Review File: Available at https://hbsn.amegroups.com/article/view/10.21037/hbsn-2025-557/prf

Funding: None.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://hbsn.amegroups.com/article/view/10.21037/hbsn-2025-557/coif). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. All procedures performed in this article were in accordance with the ethical standards of the institutional and/or national research committee(s) and with the Declaration of Helsinki and its subsequent amendments. Written informed consent was obtained from the patient for publication of this article and all accompanying images. A copy of the written consent is available for review by the editorial office of this journal.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

Cite this article as: Gao X, Huang J, Yang Z. Massive hepatic hemangioma complicated by Kasabach-Merritt syndrome. Hepatobiliary Surg Nutr 2026;15(4):127. doi: 10.21037/hbsn-2025-557

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