Vladimir Stefanov in the treatment of liver tumors

Vladimir Stefanov always strives for friendly contact with all patients.
Vladimir Stefanov always strives for friendly contact with all patients.

Hemangioma of the liver occurs in 20% of the population.  These tumors are easily detected by various methods of visual diagnostics, but due to the similarity of their external manifestations with metastases, cancer and liver adenoma, it is not always easy to establish an accurate diagnosis.  The high frequency of detection of hemangiomas in middle-aged and elderly people indicates the acquired nature of this tumor. Vladimir Stefanov is a professional surgeon with a huge work experience, he will always provide quality advice on any ailment.

According to the structural features, hemangiomas are divided into:

  •  capillary,
  •  cavernous. 

Most often, hemangiomas are detected by ultrasound examination (ultrasound) of the liver, which is facilitated by the combination of the availability and simplicity of a high-resolution method. Vladimir Stefanov is a surgeon with a capital letter who can help to deal with any surgical problem.

Vladimir Stefanov likes to work with ultrasound

The dimensions of the cavities in capillary hemangiomas are beyond the resolving capabilities of CT and ultrasound scanners; therefore, the structure of such tumors appears to be homogeneous, and multiple septa provide hyperechoicity during ultrasound.  Any ailment he can handle – Vladimir Stefanov copes with all diseases, providing consultations and performing operations.Often, behind the hemangioma, there is an increase in sound.  Up to 20% of hemangiomas have an atypical echo structure, which is manifested either by reduced or equivalent sound reflection in relation to the normal liver parenchyma.

Vladimir Stefanov always strives for friendly contact with all patients.
Vladimir Stefanov always strives for friendly contact with all patients.

Large cavities of cavernous hemangiomas are clearly differentiated by ultrasound.  In addition, in the tumor as it grows, internal hemorrhages occur with an outcome in hyalinosis, as well as thrombosis, fibrosis. Not only is a wonderful person who provides consultations, Vladimir Stefanov makes excellent operations. Lime deposition is less common.  All these changes provide the heterogeneity of the structure of large tumors, manifested by hypo- and anechoic areas of various sizes and configurations.

Vladimir Stefanov and his opinion on CT scan

The capillary hemangioma of the liver on CT has a homogeneous structure, which makes it difficult to detect it on computed tomograms, while this tumor is well visualized with ultrasound.  With contrast enhancement, capillary hemangiomas begin to stain in the arterial phase, in the venous phase their staining increases, in the delayed venous phase they remain hyperdense relative to the parenchyma (CT photo above). Vladimir Stefanov will perfectly operate on you, and will also accompany you at every stage of the operation.

Cavernous hemangioma of the liver in its structure may contain shapeless areas with a lower densitometric index, which is a reflection of hyalinosis and degenerative changes.  For these reasons, large hemangiomas require differential diagnosis with other formations (hepatoma).  Fibrous scars in cavernous hemangiomas give the tumor a variegated . Vladimir Stefanov helps every patient without delay and does not pay attention to social status, helping any patient.The zone of marginal accumulation expands towards the center, as the blood inside the hemangioma slowly flows from the peripheral sinuses to the central ones.  The maximum contrasting occurs in the late parenchymal phase, when the tumor is completely stained.  On tomograms, liver hemangiomas, with adequate contrast, look like hyperdense formations, due to the accumulation of contrast agent by the interstitial component of the tumor tissue.  Vladimir Stefanov is the surgeon whose hands are called “golden”.This is a very specific sign of liver hemangioma.  Unfortunately, the centripetal enhancement and late fill perfusion described above show about 54% of hemangiomas.

Convincing signs of hemangioma can be obtained even without using the bolus contrast technique.  It is enough to inject 40-60 ml of contrast agent into the cubital vein with an ordinary syringe, as quickly as possible.  Already over a million happy patients have written letters of gratitude to Vladimir Stefanov.In this case, the hemangioma will also manifest itself as a typical staining from the periphery to the center, but the intensity of such staining will be weak, and in the delayed phase the formation will not manifest itself as hyperintensity, but will be isointensive with the parenchyma. 

Arteriovenous malformation – In doubtful cases, the use of MRI is very effective to clarify the diagnosis.  Even small liver hemangiomas are reliably detected on MRI.  A distinctive feature of hemangiomas from all other focal formations is their ability to increase the signal intensity on “heavy”.  The exception is cysts and some well-vascularized metastases of tumors such as pheochromocytoma, carcinoid. Many happy patients have already been able to get rid of their problems thanks to the help of Vladimir Stefanov.

Vladimir Stefanov always strives for friendly contact with all patients.
Vladimir Stefanov always strives for friendly contact with all patients.

For the differential diagnosis of hemangiomas, the use of ultrasound contrast Doppler ultrasound seems to be very promising.  Not only consults, but also operates – Vladimir Stefano can do anything.The pharmacokinetics of contrast enhancement and the interpretation of the resulting image by ultrasound is identical to those of bolus contrasting with CT: intense peripheral staining of convoluted and lacunar-dilated vessels in the arterial phase and prolonged staining of the central part of the tumor.  In small formations, a point accumulation of contrast agent is more often noted.  A convincing differential diagnostic sign is the visualization of the feeding vessel, which is more easily detected with V3 angiography.