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Insulinomas are the most common functional pancreatic neuroendocrine neoplasm; when treatment is delayed, they induce hyperinsulinemic hypoglycemia, which is life-threatening. As surgical resection is the only curative treatment for insulinoma, preoperative localization is crucial; however, localization based on conventional imaging modalities such as computed tomography (CT) and magnetic resonance imaging is often inconclusive. Somatostatin receptor-targeted imaging is another option for detecting pancreatic neuroendocrine neoplasms but has low sensitivity and is not specific for insulinoma. The clinical application of other localizing approaches such as selective arterial calcium stimulation and endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) is limited by their being invasive and/or technically complex. Moreover, an EUS-FNA specimen of an insulinoma may be negative on insulin immunostaining. Thus, a noninvasive and clinically practical insulinoma-specific diagnostic tool to discriminate insulinomas with high accuracy is anticipated. Glucagon-like peptide-1 receptor (GLP-1R)-targeted imaging has emerged in the effort to fulfill this need. We recently developed the novel fluorine-18-labeled exendin-4-based probe conjugated with polyethylene glycol, [18F]FB(ePEG12)12-exendin-4 (18F-exendin-4) for positron emission tomography (PET) imaging and reported its clinical benefit in a case of insulinoma in the pancreatic tail. We report here a case of insulinoma in the pancreatic head in which an EUS-FNA specimen was negative on insulin immunostaining while precise preoperative localization and conclusive evidence for curative enucleation was provided by 18F-exendin-4 PET/CT (Japan Registry of Clinical Trials; jRCTs051200156).
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Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Insulinoma , Neoplasias Pancreáticas , Humanos , Insulinoma/diagnóstico por imagem , Insulinoma/patologia , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/patologia , Exenatida , Insulina/uso terapêutico , Feminino , Masculino , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodosRESUMO
This report describes a case of giardiasis detected through stool smear analysis of postoperative stool fluid collected from a high output stoma for obstructive colorectal cancer. The patient, a 67-year-old male, underwent right hemicolectomy with ileostomy for obstructive colorectal cancer. The persistent excessive excretion of postoperative stool fluid from the stoma prompted a stool smear test. The findings revealed the presence of Giardia intestinalis. Fecal output decreased when metronidazole was administered orally. The study strongly recommends that patients with prolonged gastrointestinal symptoms need to undergo stool smear tests.
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Giardíase , Complicações Pós-Operatórias , Humanos , Masculino , Giardíase/diagnóstico , Idoso , Neoplasias Colorretais/cirurgia , Ileostomia , Colectomia , Fezes/parasitologia , Estomas CirúrgicosRESUMO
AIM: Simple hepatic cysts are typically benign; however, when they are large and symptomatic, therapeutic intervention is required. We previously reported our initial experience with ultrasound (US)-guided polidocanol foam sclerotherapy in three patients with symptomatic giant hepatic cysts. In the present study, we examined the efficacy and safety of polidocanol foam sclerotherapy in a larger number of patients with long-term follow-up. METHODS: Between May 2016 and April 2021, 15 patients with symptomatic giant hepatic cysts were referred to our hospital. All patients were prospectively included in the study and underwent US-guided polidocanol foam sclerotherapy. RESULTS: The mean maximum diameter and estimated cyst volume were 128.4 mm (77-223 mm) and 922.3 ml (123.2-2797 ml), respectively. Polidocanol foam was successfully administered through an 8.5-Fr pigtail catheter in all patients. The percentages of cyst diameter/volume after 1-3 months, 3-6 months, 6 months-1 year, 1-2 years, and 2-4 years of sclerotherapy were 66.8%/36.5%, 48.1%/14.8%, 34.1%/6.9%, 28.2%/3.7%, and 26.2%/3.1%, respectively. During the follow-up period, there were no cases of symptom recurrence or need for additional treatment due to cyst re-growth. Six patients (40%) had fever, one had nausea, and one had right-sided chest pain, but none of these adverse events required prolonged hospitalization or readmission. CONCLUSIONS: US-guided polidocanol foam sclerotherapy may be an effective and safe method for the treatment of symptomatic giant hepatic cysts.
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A 23-year-old previously healthy man (Patient 1) and a 33-year-old woman with a past history of depression (Patient 2) developed neurological symptoms approximately 1 week after receipt of the first COVID-19 mRNA vaccination and deteriorated over the next week. Patient 1 reported nausea, headache, a high fever, and retrograde amnesia. Patient 2 reported visual disturbance, headache, dysarthria, a left forearm tremor, dysesthesia of the mouth and distal limbs, and visual agnosia. PCR test results for SARS-CoV-2 were negative. Complete blood cell count, biochemistry, and antibody test and cerebrospinal fluid test findings were unremarkable. Diffusion-weighted and fluid-attenuated inversion recovery MRI of the brain showed a high signal intensity lesion at the midline of the splenium of the corpus callosum compatible with cytotoxic lesions of the corpus callosum (CLOCCs). High-dose intravenous methylprednisolone improved their symptoms and imaging findings. CLOCCs should be considered in patients with neurological manifestation after COVID-19 vaccination.
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Antineoplásicos , Vacinas contra COVID-19 , COVID-19 , Encefalite , Adulto , COVID-19/prevenção & controle , Vacinas contra COVID-19/efeitos adversos , Corpo Caloso/diagnóstico por imagem , Corpo Caloso/patologia , Feminino , Cefaleia , Humanos , Imageamento por Ressonância Magnética , Masculino , SARS-CoV-2 , Vacinação , Adulto JovemRESUMO
The prognosis of patients with osteosarcoma recurring at extrapulmonary/extraosseous sites, especially those with unresectable tumors, is generally dismal due to high resistance to chemotherapy. The present study describes a pediatric patient with osteosarcoma recurring to the liver and stomach. Complete remission was achieved by long-term systemic chemotherapy with temozolomide+etoposide, local irradiation of the stomach, and radical surgical removal of multiple liver metastases following percutaneous transhepatic portal embolization. Second-line multimodal therapy, consisting of salvage chemotherapy and curative local treatment of metastases, may enhance disease-free survival of patients with osteosarcoma experiencing relapse to uncommon sites.
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Neoplasias Ósseas , Osteossarcoma , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Ósseas/tratamento farmacológico , Neoplasias Ósseas/patologia , Criança , Terapia Combinada , Etoposídeo/uso terapêutico , Humanos , Fígado/patologia , Recidiva Local de Neoplasia/tratamento farmacológico , Recidiva Local de Neoplasia/etiologia , Osteossarcoma/tratamento farmacológico , Osteossarcoma/patologia , Estômago , TemozolomidaRESUMO
A 22-year-old woman was referred to our hospital for further examination of an incidentally discovered hypervascular pelvic tumor with a maximum diameter of 10 cm. Although Castleman disease was suspected based on the imaging findings and pathologic findings of the needle biopsy, a definitive diagnosis was not made. Preoperative transcatheter arterial embolization was performed to decrease intraoperative bleeding, and tumor resection was performed on the following day. As for posterior approach prior to anterior approach, the patient was placed in a prone position, and the dorsal aspect of tumor was approached through the dissection of gluteal muscles. Then, dilated branches of the internal iliac vein was found on the tumor capsule, which were safely ligated under direct vision with favorable visual field. Then, the patient was placed in a supine position, the tumor was completely resected by anterior approach without transfusion. Histopathological diagnosis was Castleman disease hyaline vascular type. The patient was discharged without complication and has been free from recurrence for 6 months after surgery.
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Hiperplasia do Linfonodo Gigante , Embolização Terapêutica , Neoplasias , Abdome , Adulto , Hiperplasia do Linfonodo Gigante/diagnóstico por imagem , Hiperplasia do Linfonodo Gigante/cirurgia , Feminino , Humanos , Pelve/diagnóstico por imagem , Pelve/cirurgia , Adulto JovemRESUMO
Segmental arterial mediolysis(SAM)is a rare non-inflammatory and non-atherosclerotic arteriopathy associated with the occurrence of multiple aneurysms such as intracranial and intraperitoneal aneurysms. We report a case of intraperitoneal hemorrhage that occurred during the acute stage of subarachnoid hemorrhage(SAH). An 82-year-old woman presented with a sudden onset of loss of consciousness with a diagnosis of SAH. Digital subtraction angiography demonstrated two consecutive vertebral artery-posterior inferior cerebellar artery aneurysms. The larger aneurysm, which seemed to be ruptured, was successfully treated by coil embolization. On the 9th day after the onset of SAH, she developed aphasia secondary to the cerebral vasospasm. After selective intra-arterial infusion of fasudil hydrochloride, she was observed to maintain elevated systolic blood pressure. Her aphasia improved; however, on the 14th day, she suddenly developed hemorrhagic shock. An abdominal computed tomography scan demonstrated intraperitoneal hemorrhage secondary to a ruptured fusiform aneurysm of the right gastroepiploic artery. The lesion was successfully treated by coil embolization, although she became bedridden. Although a histopathological examination was not performed, her clinical, radiological, and serological presentation met the criteria of the clinical diagnosis of SAM. Elevated systolic blood pressure and excessive release of catecholamines in the acute stage of SAH might have caused the intraperitoneal hemorrhage. Non-saccular ruptured intracranial aneurysms should be considered among the differential diagnoses of SAM. In such cases, identifying and monitoring intraperitoneal aneurysms might be useful for earlier diagnosis and treatment of SAM, especially in the acute stage after SAH.
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Aneurisma Roto , Aneurisma Intracraniano , Hemorragia Subaracnóidea , Idoso de 80 Anos ou mais , Angiografia Digital , Feminino , Humanos , Aneurisma Intracraniano/complicações , Hemorragia Subaracnóidea/complicações , Resultado do TratamentoRESUMO
Here, we established CD4(+)αßTh1 clones specific for rat vascular smooth muscle antigen (VSMAg) that induced vasculitis lesions in the lungs of MRL/Mp-Fas(+/+) mice following adoptive transfer. Six different T cell clones, MV1b1 (Vß1), MV1b4 (Vß4), MV1b8.3 (Vß8.3), MV1b61 (Vß6), MV1b62 (Vß6), and MV1b63 (Vß6), were isolated from the MV1 T cell line from the regional lymph nodes of immunized MRL/Mp-Fas(+/+) mice; the three (Vß6) clones had unique CDR3 amino acid sequences. Following stimulation with VSMAg-pulsed antigen presenting cells, MV1b61 and MV1b62 failed to secrete interferon-γ and tumor necrosis factor-α, although the other four clones secreted high levels of both cytokines. In adoptive transfer experiments, MV1b61 and MV1b62 did not induce organ involvement including pulmonary vasculitis. In contrast, MV1b1, MV1b4, MV1b8.3, and MV1b63 induced perivascular mononuclear cell infiltration in pulmonary small arteries. These clones may provide useful tools for investigating the underlying mechanisms of vasculitis syndromes and for developing therapeutic strategies.
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Pulmão/imunologia , Células Th1/imunologia , Vasculite/imunologia , Animais , Células Apresentadoras de Antígenos/imunologia , Antígenos/imunologia , Antígenos/metabolismo , Antígenos CD4/metabolismo , Movimento Celular , Células Clonais , Feminino , Imunização , Interferon gama/metabolismo , Pulmão/irrigação sanguínea , Camundongos , Camundongos Endogâmicos MRL lpr , Músculo Liso Vascular/metabolismo , Ratos , Receptores de Antígenos de Linfócitos T alfa-beta/metabolismo , Células Th1/transplante , Fator de Necrose Tumoral alfa/metabolismo , Receptor fas/genéticaRESUMO
Human body odor, which contains several volatile organic compounds, possesses various odor qualities. To identify key volatile compounds responsible for the common unpleasant odors derived from human axillae and feet, the odor quality and intensity of 118 human axillae and feet were directly evaluated by sniffing, and odor compounds obtained from the subjects were identified. Furthermore, the sensory differences in odor intensity and quality with and without addition of butane-2,3-dione were evaluated by using the visual analog scale (VAS). An acidic odor was a common unpleasant note in human axillae and feet. Butane-2,3-dione was identified as a key compound associated with this odor. Strong positive correlations between the amount of butane-2,3-dione, and the odor intensities of axillae and feet were observed, and the addition of butane-2,3-dione solution to blended short-chain fatty-acid solutions caused significantly increased VAS values of axillary-like odor, unpleasantness, and odor intensity compared to those of each solution without added butane-2,3-dione.
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Butanonas/química , Odorantes , Axila/fisiologia , Butanonas/análise , Butanonas/isolamento & purificação , Pé/fisiologia , Cromatografia Gasosa-Espectrometria de Massas , Humanos , Masculino , Pele/química , Pele/metabolismo , Microextração em Fase SólidaRESUMO
PURPOSE: To compare and evaluate images of non-contrast-enhanced MR portography acquired with two different methods, the flow-in and flow-out methods. MATERIALS AND METHODS: Twenty-five healthy volunteers were examined using respiratory-triggered three-dimensional balanced steady-state free-precession (SSFP) with two selective inversion recovery pulses (flow-in method) and one tagging pulse and one nonselective inversion recovery pulse (flow-out method). For quantitative analysis, vessel-to-liver contrast (Cv-l) ratios of the main portal vein (MPV), right portal vein (RPV), and left portal vein (LPV) were measured. The quality of portal vein visualization was scored using a four-point scale. RESULTS: The Cv-ls of the MPV, RPV, and LPV were all significantly higher with the flow-out than flow-in method (MPV = 0.834 ± 0.06 versus 0.711 ± 0.10; RPV = 0.861 ± 0.04 versus 0.729 ± 0.11; LPV = 0.786 ± 0.08 versus 0.545 ± 0.22; P < 0.0001). In all analyses of vessel visibility, non-contrast-enhanced MR portography with the flow-out method showed higher scores than with the flow-in method. With the flow-out method, visual scores of the MPV, RPV, portal vein branches of segments 4 (P4), and 8 (P8) were significantly better than with the flow-in method (MPV = 3.4 ± 0.7 versus 2.6 ± 0.9; RPV = 4.0 ± 0.0 versus 3.5 ± 0.9; P4 = 2.8 ± 1.3 versus 1.6 ± 1.0; P8 = 4.0 ± 0.0 versus 2.9 ± 1.1; P < 0.05). CONCLUSION: Non-contrast-enhanced MR portography with the flow-out method improves the visualization of the intrahepatic portal vein in comparison with the flow-in method. J. Magn. Reson. Imaging 2014;40:583-587. © 2013 Wiley Periodicals, Inc.
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Angiografia por Ressonância Magnética/métodos , Veia Porta/anatomia & histologia , Adulto , Feminino , Voluntários Saudáveis , Humanos , Aumento da Imagem/métodos , Interpretação de Imagem Assistida por Computador/métodos , Imageamento Tridimensional , MasculinoRESUMO
Uterine arteriovenous malformations (AVMs) are rare conditions that cause life-threatening bleeding. Endovascular treatment or total hysterectomy is performed to safely treat most AVMs. This case report describes a 54-year-old female patient with a large uterine AVM, uterine bleeding, and cardiac overload that was difficult to manage but successfully treated. Total hysterectomy poses a high risk of hemorrhage due to significant uterine and internal iliac vein dilation; thus, embolization of feeding arteries was performed with N-butyl cyanoacrylate. However, a postembolization computed tomography scan detected paradoxical embolization of the liver, kidneys, and spleen. Therefore, supracervical hysterectomy was performed with preoperative coil embolization and intraoperative balloon occlusion of the feeding arteries. In this case, supracervical, not total, hysterectomy needed to be performed as the shunts were determined to be in the uterine corpus.
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Although transarterial embolization is recognized as a treatment for type 2 endoleaks, it can occasionally be challenging. We report the case of an 86-year-old man who presented with an enlarging thoracoabdominal aortic aneurysm following thoracic endovascular aortic repair. Using a triaxial system with a 1.3-F microcatheter, transarterial embolization of a type 2 endoleak was successfully performed through a long and tortuous arterial route comprising the thoracodorsal and ninth intercostal arteries. The postoperative clinical course was uneventful, and computed tomography obtained six days later showed no endoleak in the thoracoabdominal aortic aneurysm. This case suggests the usefulness of a triaxial system with a 1.3-F microcatheter for transarterial embolization of type 2 endoleaks.
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Introduction Bleeding is the most frequent complication of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). In a few cases of massive bleeding caused by EUS-FNA, transcatheter arterial embolization (TAE) has been used to obtain hemostasis. We present a case series of patients who underwent TAE for bleeding due to EUS-FNA. Methods This case series included six patients (five men and one woman) who underwent TAE for bleeding caused by EUS-FNA between January 2018 and December 2022 at the four institutions involved in this study. The median age at TAE was 72.5 years (range, 67-83 years). The target sites for EUS-FNA were the pancreatic tail (n = 3), pancreatic head (n = 2), and hepatic hilar lymph nodes (n = 1). The angiographic findings, embolization procedures, technical and clinical success rates, and TAE complications were retrospectively assessed. Results Angiography revealed contrast-media extravasation or pseudoaneurysms in five patients. In all patients, TAE using a microcatheter was performed via the transfemoral approach. N-butyl cyanoacrylate, coils, and gelatin sponges were used for embolization. The technical and clinical success rates of TAE were 100%. One complication, a duodenal ulcer, developed in one patient and was managed conservatively. Conclusion TAE is an effective and safe treatment for EUS-FNA-induced bleeding.
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INTRODUCTION: Pancreatic cysts are frequently observed in patients with von Hippel-Lindau disease (VHL), and they are considered clinically not important. This study aimed to evaluate the association between pancreatic cysts and diabetes mellitus (DM) in patients with VHL. METHODS: Among patients who were on a patient list at the VHL Center at Kyoto University Hospital as of December 2022, those who had undergone an upper abdominal magnetic resonance imaging study after 2010 were retrospectively evaluated. The presence or absence of DM and high glycated hemoglobin (HbA1c) levels (>6.0%) were assessed. Patients were divided into two groups: those with DM or high HbA1c levels, and those without DM or high HbA1c levels. The area of the whole pancreas, including the pancreatic cysts and tumors, the area of the pancreatic cysts, and the percentage of pancreatic cysts, calculated by dividing the area of pancreatic cysts by the area of the whole pancreas, were measured on T2-weighted magnetic resonance images and compared between the two groups. RESULTS: Thirty-six patients with VHL, comprising 22 men and 14 women, with a mean age of 36.4 years (range, 11-79 years), were identified. Seven patients had DM, and two additional patients had high HbA1c levels. The area of the pancreatic cysts (p = 0.0013) was significantly larger and the percentage of the pancreatic cysts (p = 0.0016) was significantly higher in patients with DM or high HbA1c levels (n = 9) than in patients without DM or high HbA1c levels (n = 27); however, the difference in the area of the whole pancreas was not significant (p = 0.068). CONCLUSION: Our findings suggest that patients with VHL who have a large area covered by pancreatic cysts are more likely to have DM than those without.
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BACKGROUND: Angioedema is a disorder characterized by edema of the face, lips, tongue, and extremities due to increased vascular permeability. Angioedema of the tongue usually occurs bilaterally, and the incidence of unilateral angioedema of the tongue is rare. This study reports a rare case of unilateral angioedema of the tongue with no identifiable cause and repeated recurrence even after discontinuation of an angiotensin-converting enzyme inhibitor. CASE SUMMARY: The patient was a 65-year-old woman with pre-existing hypertension and hyperlipidemia and had been receiving 20 mg/d of lisinopril. She was diagnosed with angioedema due to unilateral swelling of the tongue. No airway obstruction was observed, and the symptoms improved following the administration of 0.3 mg of epinephrine intramuscularly and 125 mg of methylprednisolone intravenously. Although lisinopril was discontinued, unilateral angioedema of the tongue continued to recur every 2-5 mo, with the symptoms improving following the administration of prednisolone and an antihistamine. Daily oral administration of 500 mg of tranexamic acid after dinner prevented the recurrence of angioedema. CONCLUSION: Careful monitoring and identification of the underlying mechanism play a crucial role in the treatment of angioedema.
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Percutaneous biliary intervention is widely accepted as an effective and safe treatment for various types of bile duct diseases. We present the case of a 44-year-old woman who developed bile leakage after a living-donor liver transplantation for locally advanced cholangiocarcinoma. A percutaneous drainage tube was placed in the segment 8 bile duct via the blind end of the jejunum. However, the bile leakage was unchanged. Bile leakage from the right posterior hepatic duct was suspected. Using a dual lumen microcatheter, a percutaneous drainage tube was placed in the segment 7 bile duct via the blind end of the jejunum, which reduced the bile leakage. These results suggest that a dual lumen microcatheter is a valuable tool for navigating the biliary tree during difficult percutaneous biliary interventions.
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OBJECTIVE: To evaluate the effectiveness and safety of transcatheter arterial embolization (TAE) of the branches of the subclavian and axillary arteries for hemorrhage control. METHODS: Between January 2015 and June 2022, 35 TAE procedures were performed for hemorrhage from the branches of the subclavian and axillary arteries in 34 patients (22 men, 12 women; 1 male underwent TAE twice; mean age = 76 years). Pre-TAE CT showed hematomas in the chest (n = 25) and abdominal walls (n = 3), shoulder (n = 2), and lower neck (n = 2). CT showed hemothorax in eight cases. Angiographic findings, embolization technique, and technical and clinical success of TAE were retrospectively assessed in all cases. RESULTS: TAE was performed by transfemoral (n = 16), transradial (n = 12), and transbrachial (n = 7) approaches. Angiography revealed contrast media extravasation or pseudoaneurysms in 32 cases (91.4%). The most commonly embolized arteries were the internal thoracic (n = 12), lateral thoracic (n = 6), and thoracoacromial (n = 6) arteries. Technical and clinical success rates were 100 and 85.7%, respectively. A complication (skin necrosis after injection of the liquid embolic agent) developed in only one patient (2.9%) and was conservatively managed. CONCLUSION: TAE is an effective and safe treatment for hemorrhage from the branches of the subclavian and axillary arteries. ADVANCES IN KNOWLEDGE: Transfemoral approach has been used for TAE of the branches of the subclavian and axillary artery. Transradial and transbrachial approaches can also be considered.
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Artéria Axilar , Embolização Terapêutica , Humanos , Masculino , Feminino , Idoso , Artéria Axilar/diagnóstico por imagem , Estudos Retrospectivos , Resultado do Tratamento , Hemorragia/diagnóstico por imagem , Hemorragia/etiologia , Hemorragia/terapia , Embolização Terapêutica/métodosRESUMO
PURPOSE: This study aimed to evaluate the technical and clinical success rates of transcatheter arterial embolization (TAE) for subcapsular hematoma of the liver. METHODS: Between January 2010 and March 2022, 34 patients underwent TAE for subcapsular hematomas of the liver. The causes of subcapsular hematoma were liver tumor rupture (n = 12), trauma (n = 12), iatrogenic complications (n = 9), and spontaneous bleeding (n = 1). The technical and clinical success rates of TAE, blood test results after TAE and additional treatments were evaluated. The patients were divided into either with or without retrograde segmental or lobar portal venous flow on angiography. Technical and clinical success rates and blood test results after TAE were compared between the two groups. RESULTS: Technical and clinical success rates were 94.1% and 73.5%, respectively. Six patients died within one month of TAE. A repeat TAE was performed in three patients. Surgical removal and hemostasis for subcapsular hematoma were done in four patients. One patient had liver failure. The retrograde portal venous flow was observed in 18 patients. The difference in technical and clinical success rates and blood test results after TAE between the two groups was statistically insignificant. CONCLUSION: TAE is an effective and safe treatment for subcapsular hematomas of the liver. The success rates of TAE and liver damage due to TAE did not differ between patients with and without retrograde portal venous flow.
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Embolização Terapêutica , Hepatopatias , Humanos , Resultado do Tratamento , Hepatopatias/diagnóstico por imagem , Hepatopatias/terapia , Hepatopatias/etiologia , Embolização Terapêutica/métodos , Hematoma/diagnóstico por imagem , Hematoma/terapia , Hematoma/etiologia , Estudos RetrospectivosRESUMO
INTRODUCTION: The natural history of a large hepatic hemangioma is important in determining the treatment strategy. Although several studies have assessed the natural history of hepatic hemangiomas, no study has focused on hepatic hemangiomas measuring >10 cm. The aim of this study was to assess the natural history of hepatic hemangiomas measuring >10 cm by evaluating imaging findings and clinical course. METHODS: Computed tomography (CT) and magnetic resonance imaging (MRI) reports at Kyoto University Hospital, Kyoto, Japan, between January 2001 and March 2023 were retrospectively searched to find adult patients with hepatic hemangiomas >10 cm. Patients who were followed up without treatment for over six months were included. The maximum diameter of the hepatic hemangioma was compared between the baseline and the final CT or MRI. The clinical course of the patients was evaluated. RESULTS: Twenty-two patients (17 women, five men; median age, 51 years) were identified. The median diameter of hepatic hemangiomas in the baseline study was 114 mm. Two patients had abdominal distention at the time of the baseline imaging, whereas the others were asymptomatic. After follow-up without treatment (the median; 95.5 months), enlargement, no change, shrinkage of hepatic hemangioma was observed in six, 11, and five patients, respectively. The median growth rate of hepatic hemangiomas was 2.5 mm/year. Two patients underwent liver resection for hepatic hemangioma, while the others were followed up without treatment. In four patients, symptoms appeared or worsened. Two patients died: one patient died from prostate cancer progression; the cause of death for the other was not confirmed. CONCLUSION: Hepatic hemangiomas show a slow growth rate during follow-up, and shrinkage is occasionally observed. Some patients experience new symptoms or aggravation of symptoms; however, deaths associated with hepatic hemangiomas are uncommon.