Introduction
In the article titled “Case Report: Congenital hepatic hemangioma with arteriovenous fistula: 2-year multidisciplinary management and outcomes”, Mao et al. reported a neonate with hepatic congenital hemangioma (CH) treated with multidisciplinary managements, including oral propranolol and transarterial embolization (TAE) (1). We have a few comments on the diagnosis and management of hepatic CH, and some causes of encephalomalacia.
Comments and discussion
- 1.
Hepatic CH is not infantile hemangioma, oral propranolol is incorrect. For medical management of vascular anomalies, beta blockers are only used to treat infantile hemangioma in current evidenced literature. Based on medical history and classic imaging findings provided by authors, a typical hepatic CH can be confirmed. The authors appeared to be unfamiliar with certain classic literature in the field (2–6).
- 2.
Causes of severe iatrogenic encephalomalacia
Arteriovenous shunting and pulmonary hypertension are common in congenital hemangiomas. Following transarterial particulate embolization, embolic materials may migrate into the pulmonary arteries. In a pediatric patient with concurrent pulmonary hypertension, atrial septal defect, and patent ductus arteriosus, a right-to-left shunt (Eisenmenger phenomenon) could develop. This may allow embolic materials to bypass the pulmonary circulation and enter the left heart, ultimately leading to cerebral infarction. Therefore, the encephalomalacia is of iatrogenic origin and unrelated to the congenital hemangiomas. These contraindications of embolization can be found in some classic literature studies (7, 8).
Consequently, this is not a unique baby but a common case of hepatic CH, occurring severe iatrogenic sequelae. Therefore, we suggest that this article should be majorly revised or withdrawn.
Statements
Author contributions
HW: Conceptualization, Writing – original draft. ZG: Investigation, Supervision, Validation, Writing – review & editing.
Funding
The author(s) declare that no financial support was received for the research and/or publication of this article.
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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The author(s) declare that no Generative AI was used in the creation of this manuscript.
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References
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2.
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GongXYangMZhangZQiuTZhouJShanWet alClinical characteristics and managements of congenital hepatic hemangioma: a cohort study of 211 cases. Hepatol Int. (2025) 19(3):682–91. 10.1007/s12072-024-10756-5
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Summary
Keywords
hepatic congenital hemangioma, arteriovenous fistula, pulmonary hypertension, atrial septal defect, patent ductus arteriosus, Eisenmenger phenomenon, cerebral infarction, transarterial embolization
Citation
Wang H and Guo Z (2025) Commentary: Case Report: Congenital hepatic hemangioma with arteriovenous fistula: 2-year multidisciplinary management and outcomes. Front. Pediatr. 13:1634333. doi: 10.3389/fped.2025.1634333
Received
24 May 2025
Accepted
02 July 2025
Published
17 July 2025
Volume
13 - 2025
Edited by
Yi Ji, Sichuan University, China
Reviewed by
Kaiying Yang, Guangzhou Women and Children’s Medical Center, China
Updates
Copyright
© 2025 Wang and Guo.
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*Correspondence: Zhengtuan Guo 397166844@qq.com
Disclaimer
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.