PEIR Digital Library

Welcome to the Pathology Education Informational Resource (PEIR) Digital Library, a multidisciplinary public access image database for use in medical education.

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RADIOLOGY: HEPATOBILIARY: Case# 67: HEMANGIOMA. The patient is a 47-year-old female who underwent pelvic ultrasound earlier today for abdominal pain. Ultrasound revealed a large fibroid and heteroechoic liver lesions. CT of the abdomen is requested to further evaluate. There are no prior CT studies available for comparison. Two predominately hypodense lesions are noted in the lateral segment of the left hepatic lobe and inferior margin of the right hepatic lobe corresponding with the lesions seen on ultrasound. These lesions demonstrate nodular peripheral enhancement and become hyperdense to surrounding liver parenchyma on delayed images. Hemangiomas are a common incidental finding on routine imaging surveys of the liver and may pose an important diagnostic problem in patients with a known primary malignancy. Hemangiomas are the most common benign tumors of the liver. They are usually found in the right hepatic lobe and are frequently subcapsular in location. The CT appearance of hemangiomas after a bolus injection of iodinated contrast material with dynamic scanning demonstrates a dense peripheral enhancement, which eccentrically fills in toward the center of the lesion on delayed scan. This is the most common finding and is seen in approximately 85% of lesions greater than 3cm in size. The angiographic appearance of a hemangioma is classic, with puddling of contrast material within the tumor, which remains visible on delayed, prolonged filming sequences. Some hemangiomas exhibit atypical features such as cystic areas probably caused by hemorrhage or thrombosis. Other lesions simply fail to show the typical pattern well enough to confirm the diagnosis.

Peter Anderson