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

Sep 30, 2026

An 80-year-old woman with chronic eosinophilic pneumonia (CEP), severe persistent asthma, idiopathic urticaria, fibrous dysplasia of bone, osteoporosis from long-term oral corticosteroids, and arthralgia presented with abdominal discomfort. CT imaging revealed a large hepatic hemangioma (~8.2 x 6.4 cm). Arterial embolization did not improve size or symptoms, and eight years later CT showed growth to 10.5 x 7.3 cm with mass effect on the right kidney, duodenum, and vertebral column shift. CEP and asthma were controlled with reslizumab after desensitization.

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Abstract

Introduction

Case details and imaging course

Treatment considerations

How to cite this article

Review began 11/12/2025 Review ended 12/09/2025 Published 12/10/2025 © Copyright 2025 Khazar et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. DOI: 10.7759/cureus.98917 Open Access Case Report A Case of an 80-Year-Old Woman With Chronic Eosinophilic Pneumonia and Clinically Significant Giant Hepatic Hemangioma Vicken Khazar 1, Samuel Escobar 2, Amy Huang 3 , Anthony M. Szema 4 1. Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, USA 2. Allergy and Immunology, Warren Alpert Medical School of Brown University, Providence, USA 3. Allergy and Immunology, Three Village Allergy and Asthma, PLLC, Centereach, USA 4. Allergy and Immunology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, USA Corresponding author: Vicken Khazar, [vicken.khazarmed@gmail.com](vicken.khazarmed@gmail.com) 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. Categories: Internal Medicine, Allergy/Immunology, Gastroenterology Keywords: chronic eosinophilic pneumonia, giant hepatic hemangioma, hepatology, medical management of hepatic hemangioma, rare benign hepatic tumor Introduction Hepatic hemangiomas (HH) are thought to be vascular malformations characterized by disorganized cavity enlargement via dilation, as opposed to hyperplasia or hypertrophy, and result in abnormal growth of blood vessels within the liver. They are the most common benign hepatic tumor at encompassing 20% of cases, typically present in individuals ages 30-50 years, and are more common in women than men [1-2]. While most HHs are small and benign, these tumors are considered “giant” when their diameter exceeds 5 cm and “enormous” when greater than 15cm. Hemangiomas are most commonly asymptomatic and are found incidentally on unrelated radiologic imaging, falling in the tumor category of “incidentalomas,” with a median age of presentation at 46 years old [1,3] . When giant hemangiomas present symptomatically, it is mo

FAQs

What findings led to the diagnosis of the hepatic hemangioma in this case?

Abdominal and pelvic CT showed a hepatic hemangioma measuring approximately 8.2 x 6.4 cm, later increasing to 10.5 x 7.3 cm with mass effect.

How did the initial treatment for the hemangioma affect the patient?

The patient underwent arterial embolization, but there was no improvement in either size or symptoms.

Why was surgical resection ultimately not pursued in this report?

Although criteria for resection were discussed and referral for excision occurred, no treatment was advised following the principle of primum non nocere, opting for close observation due to comorbidities and controlled CEP/asthma.

Sep 30, 2026

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