GIANT HEPATIC HEMANGIOMA IN A SPACEFLIGHT PARTICIPANT

An orbital spaceflight participant was discovered to have an asymptomatic 9.5 cm hepatic hemangioma. During follow-up, the hemangioma enlarged by 2.5 cm. While giant hemangiomas are not likely to spontaneously bleed or greatly increase hemorrhage risk with trauma, those that bleed may produce catastrophic results. The decision to fly someone in space with a medical condition is based on risk estimation that includes the medical condition, effect of microgravity and acceleration on the condition, risk of an adverse even, potential outcome from an adverse event, and how an adverse event would affect the training or mission. In this case surgical correction of the hepatic hemangioma was required before approval for flight. The rationale included the following factors. 1) hemangioma growth-most do not grow once discovered, 2) while the imaging studies showed the characteristic appearance of a hemangioma, definitive tissue diagnosis was not possible, 3) a large portion of the hemangioma was subcapsular, 4) while the chance for spontaneous bleeding was remote, hemorrhage in space or at a landing site following a traumatic landing would be life-threatening. Several surgical options are available for treatment of giant hepatic hemangiomas, but in this case an open technique was chosen to remove the hemangioma, spare normal liver tissue, and address smaller secondary hemangiomas. This presentation will cover the differential, incidence, indications and risk for surgery, and consider individuals who will be exposed to isolation or the performance environment.