concerned about recurring URQ pain/liver hemangioma

[stefropluto]

About a year & a half ago, I began having discomfort, sometimes pain, in the right side of my abdomen.  At first it was all over the right side, upper & lower, wrapping around into my back & even down into my hip.  Now it's usually just in the liver area, sometimes radiating around and down.  I saw my OB-GYN, who felt my ovaries, said they were fine.  I then had an abdominal ultrasound to rule out gall stones.  (April 2005)  The report said that the liver, pancreas, gallbladder were normal, but that there was "a 1.1 x 1.1 cm. echogenic nodule in the right hepatic lobe which may represent an incidental hemangioma".  I had a follow-up ultrasound in July 2005.  The impression was "A vague 1 cm echogenic lesion in the liver dome which is likely the same questioned hemangioma on prior study.  It is otherwise unchanged in size.  An additional 6-9 month follow-up ultrasound is suggested to ensure continued stability."  The final ultrasound was done on Feb. 2006.  The report said, "Just under the hemidiaphragm there is a 1.2 cm hyperechoic mass lesion consistent with benign hemangioma.  The finding is of doubtful clinical significance.", then, "Benign appearing mass lesion in the superior liver consistent with incidental hemagioma."  I also had a contrast CT scan in July 2005 of my pelvic area & abdomen, and that was normal, except for the hemangioma.  They don't want to follow this anymore.  My concern is this:  I am still having pain in that area, sometimes all over the right side of my abdomen and into my back.  I haven't had a colonoscopy, doctor didn't feel I need one, and yet I know that colon tumors don't show up on ultrasounds or CT scans.  So, I'm worried that I could have a tumor in the "hepatic flexure" of my colon, and that the "hemangioma" may be a tumor.  My doctor told me I have IBS, but I have none of the classic symptoms of IBS.  I honestly think he's written me off as a hypochondriac, but this pain is very real and almost non-stop.  
Also, my GGT liver enzyme is slightly elevated, but that could be because I take Dilantin.
Thanks for reading all of this!!  I wanted you to have all the info I have.

[rozgw]

Hi. I'm a doctor and have just been diagnosed with liver haemangioma.  My pain started 1 year ago and I was convinced it was gallbladder pain - it was continuous, lasted 12 hours and was three days before my wedding so I then convinced myself it was stress and ignored it.  It didn't come back until 2 months ago. There is tenderness precisely in the gallbladder point and this time I went to the GP as it lasted longer and I couldn't sleep unless I was propped bolt upright and took enough analgesics to make myself drowsy. I had an ultrasound scan on the day I saw my doctor - the radiologist said I had no gallstones but she kept looking at my liver and muttered something about referring me to a specialist and arranging more scans.  I had a CT which looks like I have 4 haemangiomata, the largest 7cm in diameter.
From what I've read, I would not take medications which affect blood flow in an attempt to stem the pain - pain is caused either by bleeding into the tumour, or by blood clots.  Therefore taking meds to increase blood flow could exacerbate pain if caused by bleeding.  Likewise, typically blood flow within haemangioma is sluggish already and taking something to slow flow is liable to increase the risk of clot (thrombosis).
I think at this stage finding a method of controlling pain is the first port of call - obviously there is a problem with doctors not taking the pain seriously generally.  But bear in mind there are risks with any of the definitive procedures such as radiofrequency ablation, embolism and surgery, and it may just be that until the lesion reaches a certain size the risks outweigh the benefits.
Having said this, if you have pain from haemangioma you should be under a gastroenterologist to monitor it rather than a general physician.
If pills are not enough ask about referral to a pain specialist for advice.
I'm relatively recently diagnosed only - but appears that palpation by the doctor, bumpy car journeys, etc set off my pain and I'll definitely be seeking more definitive solutions than pain control long term as I can't work when the pain is active - can't sleep properly, can't drive to work etc.

[JCP TAC]

Just joining the group...I, too have constant pain in my right abdominal area and have been diagnosed with a liver hemangioma. I have had both a colonoscopy (normal) and CT scan of that area (normal except for the hemangioma).  I am worried that something else might be causing the pain, but my doctor has not recommended further tests.  Any ideas?

My doctor did suggest that I not take birth control pills because they contain estrogen. Since alcohol raises estrogen levels, I am assuming it would be better to abstain from that as well.  Is anyone taking any special dietary supplements?  This is all so new to me.

[cs817]

Hello Everyone.  I am confused, frustrated, and getting fed up. I am not happy that you have a lot of the same problems I am going thru, but glad to find someone who understands. 3 yrs ago, I started having pain under my right rib and into the right side and constant nausea and my belly gets swollen and inflamed.. My dr and I noted I had all the symptoms of gallstones. Was sent for CT scan. Ct scan showed nothing wrong. This has never stopped bothering me. I recently went for an ultrasound to see if it could be something with the female organs. (I am a 45 yr old female) The tech found nothing wrong with female parts but did see a hemangioma near the liver. I was sent for another ct scan. This scan showed a hemangioma "near" the liver. Now the dr says the hemangioma is small and is not causing me any problems even though nothing else shows! I still have gallbladder symptoms, as in, certain foods give me diahrea, pain and I've noted that if I drink a soda my whole right side will burn. I take cranberry pills and acidophillus, and have now started taking gingko biloba and co-q10 as I've read they promote blood flow, just hoping they could straighten this up as I have no other answers.  The thing that makes me mad is if there are no other signs to go on, then why is it assumed that this hemangioma is not causing me problems?! Why are we supposed to wait untill it grows to a certain size to have it removed?  Also, I've read that babies who are born with this, have to have surgery right away as it may cause heart problems? So, does this mean it does indeed mess with the blood flow? Then, why are we told it's causing no problems? I mean, if we are having the pain, how can we be told the pain is not coming from this if they find nothing else to be causing it?  I now am supposed to go back for an MRI in 3 months. All my blood tests were okay except the thyroid is either a little hyper or hypo. (cant remember as my mind got stuck on "liver hemangioma" once it was said. When the doc said I am having no symptoms, I reminded him that I have complained of pain in the right rib and side for 3 yrs. He said "Well, a lot of people get these and they cause no problems. Have a nice Christmas".  I even asked what I can do to help this situation, as in diet or anything.  He said "Dont stress about it."  Well, it's hard not to stress about it when it hurts! I've even started getting bad leg cramps.  Does anyone know what this comes from?  Does anyone know what can be done to help ourselves untill we can prove we need help with this?  I am the type that will research things to try to help anyone but it appears there just are no answers here for this! On the gallbladder site, some people say not all gallstones are spotted with these tests. So, if a gallstone got stuck in a duct, would anything form around it that would have this same appearance? As I have said, I am really confused here and keep thinking this seems more like a gallbladder problem!  Is everyone feeling just as frustrated as I am???

[J3NNI]

A related discussion, What can i do for the pain? was started.

[kaety]

A related discussion, why is this not a concern for any Dr. was started.

[Lenny46]

A related discussion, Liver Hemangioma was started.

[millygirl]

Funny, I too have a liver hemangioma and have been tested for everything else which have all came back normal and I also have pain on my right side under my rib area and across my upper-mid abdominal area. Sounds like hemangioma pain to me!!

[stefropluto]

Me again.  I will talk to the doctor about these tests.  The symptoms do sound like a gallbladder problem.  So, you don't think it sounds like something that could be a colon issue?  No colonoscopy?

[stefropluto]

It's me again, the poster of the question.  Maybe I should mention that I am female, 37, and the mother of three.  Also, there is no colon or liver cancer in my family.  There is cancer of various other kinds, but in old age only.

[Kevin Pho, MD]

It is unlikely that the pain is being caused by the hemangioma.  I would look for other causes.

This can include further tests of the gallbladder.  This can include a HIDA scan with CCK stimulation, looking at the gallbladder ejection fraction.  If low, removing the gallbladder can be considered for treatment.  

I would also consider evaluation of the upper digestive tract with an upper GI series and/or an endoscopy.  

These options can be discussed with your gastroenterologist.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
kevinmd_