# A Case of an 80-Year-Old Woman With Chronic Eosinophilic Pneumonia and Clinically Significant Giant Hepatic Hemangioma

## TL;DR

An 80-year-old woman with multiple health issues had a large, growing hepatic hemangioma that did not require surgery due to her age and comorbidities.

## Contribution

This case highlights the management of a mega hepatic hemangioma in an elderly patient with multiple comorbidities, emphasizing non-intervention when surgery is not feasible.

## Key findings

- The patient's hepatic hemangioma increased in size over eight years but did not require surgical intervention.
- Despite meeting criteria for resection, the patient was managed with observation due to her age and comorbidities.
- The case suggests that elderly patients with comorbidities can tolerate large hemangiomas without surgery.

## Abstract

An 80-year-old woman with a history of chronic eosinophilic pneumonia (CEP), severe persistent asthma, concomitant severe idiopathic urticaria, fibrous dysplasia of bone, osteoporosis resulting from years of oral corticosteroid usage, and arthralgia, presented to the allergy and immunology clinic with abdominal discomfort. Abdominal and pelvic CT scan showed a hepatic hemangioma, measuring approximately 8.2 x 6.4 cm. The patient underwent arterial embolization with no improvement in size or symptoms. CT scan of the same area taken eight years later had the same large, well-defined hypodense lesion in the right hepatic lobe that increased in size to 10.5 x 7.3 cm. The larger hemangioma now resulted in a mass effect on the upper pole of the right kidney, encroaching on the second portion of the duodenum, and pushing the vertebral column to the left. The patient’s CEP was well controlled after desensitization to reslizumab, which initially induced urticaria. Her asthma symptoms are well controlled with reslizumab.

Our patient demonstrates that, even in older age groups, it is still possible to present with mega hepatic hemangiomas, despite the median age of presentation being 46. Patients who experience abdominal symptoms, increased hemangioma size, and anxiety frequently undergo surgical resection. Our patient also met the criteria for a resection. The patient was referred to the University of Pittsburgh for excision. However, despite her CEP and asthma under control, following the principle of primum non nocere (first, do no harm), no treatment was advised, opting for close observation. While larger hemangiomas have been reported, this case demonstrates that even in the elderly, with multiple co-morbidities, one may tolerate a growing mega hepatic hemangioma. Age and comorbidity may preclude operative therapy.