Hepatic hemangiomas: the various imaging avatars and its mimickers

Mathew, Rishi Philip; Sam, Medica; Raubenheimer, Monique; Patel, Vimal; Low, Gavin

doi:10.1007/s11547-020-01185-z

Cited by 36 publications

(39 citation statements)

References 38 publications

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“…CHs are typically T2WI hyperintense due to the long T2 relaxation time in these lesions. MRI contrast enhancement patterns are similar to those described for CT; however, some CHs show slow enhancement with fill-in on delayed phase images, and rarely a centrifugal (inside-out) enhancement pattern (50).…”

Section: Cavernous Hemangiomasupporting

confidence: 63%

Radiologic-Pathologic Correlation of Liver Tumors

et al. 2021

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Radiologic and pathologic features of common and/or critical tumor or tumor-like diagnoses (lesions) of the liver are discussed within. Hepatocellular lesions (focal nodular hyperplasia, hepatocellular adenoma, hepatocellular carcinoma, and hepatoblastoma), biliary lesions (mucinous cystic neoplasm and intrahepatic cholangiocarcinoma), vascular mesenchymal lesions (cavernous hemangioma, epithelioid hemangioendothelioma, and hepatic angiosarcoma), and metastatic malignancies are the primary focus, although a more comprehensive list of lesions is also provided. Definitions, distributions, gross appearances and microscopic pathological features are introduced first, followed by radiologic correlation. Multiple imaging modalities are explored with an emphasis on those that provide the greatest value for the lesion under evaluation. A common understanding of the features of both diagnostic specialties will allow for high-quality correlation and subsequent high-quality patient care. Representative images highlighting important features are also presented.

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Section: Cavernous Hemangiomasupporting

confidence: 63%

Radiologic-Pathologic Correlation of Liver Tumors

et al. 2021

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“…Most HHs are found in women within the fourth and fifth decade of life and often originate from the right hepatic lobe ( 23 , 28 ). Typical HHs can be diagnosed straightforward by a characteristic imaging appearance, with the reported diagnostic sensitivity and specificity of ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) for HHs being 96.9% and 60.3, 98.3% and 55, 98, and 99%, respectively ( 5 , 16 ). The unique imaging features of HHs are the presence of peripheral nodular enhancement and progressive centripetal fill-in ( 5 , 16 ).…”

Section: Discussionmentioning

confidence: 99%

“…Typical HHs can be diagnosed straightforward by a characteristic imaging appearance, with the reported diagnostic sensitivity and specificity of ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) for HHs being 96.9% and 60.3, 98.3% and 55, 98, and 99%, respectively ( 5 , 16 ). The unique imaging features of HHs are the presence of peripheral nodular enhancement and progressive centripetal fill-in ( 5 , 16 ). Important ultrasonographic findings of HHs are characterized as the absence of a lateral shadow (100%) and no attenuation of posterior echoes (100%), while the presence of a hyperechoic rim is useful for detecting isoechoic hemangioma ( 29 ).…”

Section: Discussionmentioning

confidence: 99%

Giant Hepatic Hemangioma Regressed Significantly Without Surgical Management: A Case Report and Literature Review

et al. 2021

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Hepatic hemangioma (HH) is a congenital vascular anomaly comprising networks of abnormal blood and/or lymphatic vessels with endothelial cell proliferation. Their pathophysiology is not fully understood, and no specific drug is available to treat them. Conservative management, which limits observation, is preferred for most patients. A HH larger than 4 cm is considered a giant HH that may be treated using surgery ranging from embolization to hepatic resection or liver transplantation. Here, we describe a case with multiple and giant HHs that regressed significantly after treatment with azithromycin (AZM). A systematic literature review of HH and the effects of AZM on angiogenesis was then conducted.

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“…The so-called atypical hemangioma may actually be a misdiagnosed hepatocellular carcinoma or cholangiocarcinoma. Therefore, the responsibility of these patients should be assumed by specialized teams including dedicated radiologists ( 21 ). Sixteen of the 24 patients in this series had undergone a CT or MRI examination.…”

Section: Discussionmentioning

confidence: 99%

Malignant Tumors Misdiagnosed as Liver Hemangiomas

et al. 2021

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Background and Aim: To derive lessons from the data of patients who were followed for various periods with the misdiagnosis of liver hemangioma and eventually found to have a malignancy.Material and Methods: The records of 23 patients treated between 2003 and 2018 were analyzed retrospectively.Results: Twelve patients were men and 11 were women; median (range) age was 55 (35–80). The principal diagnostic modality for the initial diagnosis was ultrasonography (n:8), magnetic resonance imaging (MRI) (n:13), and computed tomography (CT) (n:2). At our institution, MRI was performed in 16 patients; the diagnosis was made with the available MRI and CT studies in five and two patients, respectively. In other words, the ultrasonography interpretations were not confirmed on MRI; in others, the MRI or CT examinations were of low quality or they had not been interpreted properly. Fifteen patients underwent surgery; the other patients received chemotherapy (n:6) or chemoembolization (n:2). The misdiagnosis caused a median (range) 10 (0–96) months delay in treatment. The final diagnoses were hepatocellular carcinoma in 12 patients, cholangiocarcinoma in four patients, metastatic mesenchymal tumor, metastasis of colon cancer, metastatic neuroendocrine carcinoma, sarcomatoid hepatocellular carcinoma, angiosarcoma, thoracic wall tumor, and metastatic tumor of unknown primary in one patient each.Conclusions: High-quality MRI with proper interpretation and judicious follow up are vital for the accurate differential diagnosis of liver lesions.

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Hepatic hemangiomas: the various imaging avatars and its mimickers

Cited by 36 publications

References 38 publications

Radiologic-Pathologic Correlation of Liver Tumors

Radiologic-Pathologic Correlation of Liver Tumors

Giant Hepatic Hemangioma Regressed Significantly Without Surgical Management: A Case Report and Literature Review

Malignant Tumors Misdiagnosed as Liver Hemangiomas

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