Imaging Sciences Interesting Cases
Case 5
Scott Cassar, MD
Clinical Presentation: A 76-year-old female with acute chest pain, tachycardia, and shortness of breath. Contrast enhanced CT revealed bilateral pulmonary emboli. This hepatic lesion was incidentally found and later evaluated with MRI.
Imaging Findings:
Figure 1: NECT; 3 cm paracaval lesion in the medial right hepatic lobe isointense to blood.
Figure 2: CECT ; early peripheral, discontinuous nodular enhancement of the lesion.
Figure 3: MR - T1 pre-contrast sequence; paracaval lesion isointense to blood.
Figure 4: MR - T1 post-contrast sequence; peripheral nodular discontinuous enhancement in the arterial phase.
Figure 5: MR - T2; hyperintense lesion, with signal intensity similar to CSF.
Diagnosis: Hepatic Cavernous Hemangioma
Differential includes peripheral (intrahepatic) cholangiocarcinoma and hypervascular metastases.
Discussion: A hepatic cavernous hemangioma is the most common benign tumor of the liver. Histologically, it is a well-circumscribed mass of blood-filled spaces lined by a single layer of endothelial cells on thin, fibrous stroma. Most hemangiomas are solitary and peripherally located. They occur sporadically and are usually asymptomatic.
Hemangiomas are well-circumscribed, round or lobular lesions, with the following MR imaging characteristics:
- T1WI - hypointense to liver parenchyma
- T2WI - hyperintense to liver and spleen parenchyma
- Dynamic contrast enhanced imaging (3 enhancement patterns):
- immediate uniform enhancement
- peripheral enhancement with centripetal progression to uniform enhancement
- peripheral nodular enhancement with centripetal progression but persistent central hypointensity
References:
- Federle, Michael P. Hepatic cavernous hemangioma. 9/21/2006. https://my.statdx.com.
- Siegelman, Evan S. Body MRI. pps 21-26. Elsevier Sauders, Philadelphia. .2005.