MedPix Medical Image Database

COW - Case of the WeekCase Contributor: Brittany RitchieAffiliation: National Capital Consortium

MedPix No: 12635 - HistoryPt Demographics: Age = 38 y.o. Gender = woman38 y/o woman to evaluate liver lesion.

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MedPix No: 12635 - EXAM & LABSNormal AST, ALT, Alk Phos, and Total Bilirubin.

Hemangioma of Liver

Non-contrast axial CT image of the liver demonstrating a large hypoattenuating lesion in the peripheral subcapsular right lobe of the liver.

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Liver Hemangioma

During the arterial phase of contrast enhancement there is peripheral puddling of contrast (nodular enhancement).

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Hepatic Hemangioma

Dynamic enhanced images in portal venous phase demonstrating shows progressive discontinuous peripheral puddling of contrast enhancement.

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Hemangioma

Contrast enhanced axial CT image of the liver in portal venous phase demonstrating a large hypodense lesion in the right lobe of the liver with progressive discontinuous peripheral puddling of contrast enhancement.

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Hemangioma

Contrast enhanced axial CT image of the liver in portal venous phase demonstrating a large hypodense lesion in the right lobe of the liver with progressive discontinuous peripheral puddling of contrast enhancement.

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Hemangioma of the liver

Delayed images from the dynamic contrast enhanced axial CT shows *fill=in* of the lesion.

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FINDINGSDiscontinuous peripheral pooling of contrast enhancement in the arterial phase with progressive filling seen in the portal venous phase and prolonged enhancement of the lesion in delayed images on a three phase enhanced liver CT.

DIFFERENTIAL DIAGNOSISWhat is your Differential Diagnosis?DDX of hypodense liver lesion:-    Cavernous hemangioma-    Metastatic disease -    HCC-    Focal Nodular Hyperplasia-    Hepatic cyst-    Fibrolamellar Carcinoma-    Lymphoma-    Hepatic Adenoma-

Diagnosis: Liver HemangiomaDx Confirmed by: Imaging is diagnostic. No further confirmation required.

DISCUSSIONNOTE: These are dynamic enhanced images that confirm benign hemangioma. The discontinuous peripheral pooling of contrast enhancement in the arterial phase - followed by progressive filling seen in the portal venous phase - with prolonged enhancement of the lesion on the delayed images - is classic for hemangioma.