Huaijie Wang
Zhengtuan Guo*
- Department of Pediatric Surgery & Vascular Anomalies, Xi’an International Medical Center Hospital, Xi’an, China
A Commentary on
By Mao R, Ruan W, Zhu J, Li L, Jiang H and Li Y (2025). Front Pediatr. 13:1511892. doi: 10.3389/fped.2025.1511892
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 Therefore, we suggest that this article should be majorly revised or withdrawn.
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.
Generative AI statement
The author(s) declare that no Generative AI was used in the creation of this manuscript.
Publisher's note
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.
References
1. Mao R, Ruan W, Zhu J, Li L, Jiang H, Li Y. Case report: congenital hepatic hemangioma with arteriovenous fistula: 2-year multidisciplinary management and outcomes. Front Pediatr. (2025) 13:1511892. doi: 10.3389/fped.2025.1511892
2. Iacobas I, Phung TL, Adams DM, Trenor CC 3rd, Blei F, Fishman DS, et al. Guidance document for hepatic hemangioma (infantile and congenital) evaluation and monitoring. J Pediatr. (2018) 203:294–300.e2. doi: 10.1016/j.jpeds.2018.08.012
3. Christison-Lagay ER, Burrows PE, Alomari A, Dubois J, Kozakewich HP, Lane TS, et al. Hepatic hemangiomas: subtype classification and development of a clinical practice algorithm and registry. J Pediatr Surg. (2007) 42(1):62–7; discussion 67–8. doi: 10.1016/j.jpedsurg.2006.09.041
4. Kulungowski AM, Alomari AI, Chawla A, Christison-Lagay ER, Fishman SJ. Lessons from a liver hemangioma registry: subtype classification. J Pediatr Surg. (2012) 47(1):165–70. doi: 10.1016/j.jpedsurg.2011.10.037
5. Lee BB, Baumgartner I, Berlien HP, Bianchini G, Burrows P, Do YS, et al. Consensus document of the international union of angiology (IUA)-2013. Current concept on the management of arterio-venous management. Int Angiol. (2013) 32(1):9–36.23435389
6. Gong X, Yang M, Zhang Z, Qiu T, Zhou J, Shan W, et al. Clinical characteristics and managements of congenital hepatic hemangioma: a cohort study of 211 cases. Hepatol Int. (2025) 19(3):682–91. doi: 10.1007/s12072-024-10756-5
7. Dickie B, Dasgupta R, Nair R, Alonso MH, Ryckman FC, Tiao GM, et al. Spectrum of hepatic hemangiomas: management and outcome. J Pediatr Surg. (2009) 44(1):125–33. doi: 10.1016/j.jpedsurg.2008.10.021
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: 2 July 2025;
Published: 17 July 2025.
Edited by:
Yi Ji, Sichuan University, ChinaReviewed by:
Kaiying Yang, Guangzhou Women and Children’s Medical Center, ChinaCopyright: © 2025 Wang and Guo. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Zhengtuan Guo, Mzk3MTY2ODQ0QHFxLmNvbQ==