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Multiple hepatic hemangiomas: failure of corticosteroid therapy and successful hepatic artery ligation.

Multinodular hemangiomatosis of the liver generally occurs in the first six months of life, with the triad of hepatomegaly, high-output congestive heart failure, and cutaneous hemangiomas. 1 Early reviews described a poor prognosis with death, generally due to intractable congestive heart failure, occurring within the first year. 1,2 More recent reports suggest that a favorable outcome usually results from vigorous supportive care and high-dose corticosteroid therapy. 2-4 We have recently encountered two patients, however, who received long-term high-dose corticosteroid therapy without apparent response. In one instance, spontaneous involution and hemodynamic improvement was noted; in the other, hepatic artery ligation was performed successfully. Both patients are alive and well more than two years after diagnosis. Report of Cases .—Case1.—This infant was well until 3 months of age when poor feeding, respiratory distress, and two episodes of dusky skin color with feedings were noted. Physical examination disclosed an acutely ill