Peliosis hepatis presenting as a multifocal hepatic pseudotumor: MR findings in two cases

Abstract

Two cases of pseudotumoral peliosis hepatis are presented with emphasis on MRI findings. One patient had four individual lesions, the other had two. Image characteristics in both were: heterogeneic signal intensity on T1-weighted images (T1WI) with areas of high-, intermediate, and low signal intensity; heterogeneic signal intensity on T2WI with presence of numerous intralesional "cystic" hyperintense areas with a hypointense border. Signal intensities on T1WI were iso- to hypointense in one case and mild central hyperintensities were demonstrated in the other case, probably due to intra-lesional hemorrhage or diffuse accumulation of fresh clotting within the sinusoids. One case demonstrated early enhancement of the peripheral borders in the arterial phase, and both demonstrated enhancement in the portovenous and late phases. One case was studied with Gd-BOPTA and iron oxides and demonstrated enhancement with both products, suggestive for the presence of hepatocytes and Kupffer cells. This is the first report of the use of hepato-specific contrast agents in this entity. Spontaneous regression of the lesions was demonstrated on a follow-up MR examination in one case.

Peliosis and gummatous syphilis of the liver: A case report

“…The lesion www.wjgnet.com varies from 1 mm to several centimeters with multiple blood-filled cavities [2,3] . The lesions typically involve the whole liver, but local peliosis hepatis (also called peliosis hepatis pseudotumor) has also been reported [4] , like our case.…”

“…However, peliosis hepatis is associated with drugs (anabolic steroids, oral contraceptives, etc), malignant tumor (particularly hepatocellular carcinoma), and chronic infections (pulmonary tuberculosis, leprosy and HIV infections) [2][3][4] . Peliosis hepatis accompanying syphilis infection has not, to our knowledge, previously been reported.…”

“…The imaging findings of peliosis hepatis are variable depending on the pathologic patterns, lesion size, extent of communication with sinusoids, and complications such as thrombosis or haemorrhage within the lesion and concomitant hepatic steatosis [2][3][4] . Conventional gray-scale sonography shows hyperechoic lesions in patients with a healthy liver, homogeneous hypoechoic lesions in patients with hepatic steatosis and heterogeneous hypoechoic lesions if complicated by hemorrhage.…”

“…Conventional gray-scale sonography shows hyperechoic lesions in patients with a healthy liver, homogeneous hypoechoic lesions in patients with hepatic steatosis and heterogeneous hypoechoic lesions if complicated by hemorrhage. Absence of a mass effect on peripheral blood vessels is considered characteristic of a peliosis hepatis pseudotumor [3,4] . On unenhanced CT, peliotic lesions usually have multiple areas of low attenuation, calcifications and hemorrhage within the lesions have also been described [2] .…”

Spontaneous liver rupture in a patient with peliosis hepatis:A case report

“…The etiolog y of PH is still unknown. Sinusoidal obstruction, hepatocellular necrosis, and direct injury to the sinusoidal barrier seem to be the most likely mechanism in adults [3] . PH is usually associated with chronic pathologic conditions, including cystic fibrosis, and human immunodeficiency virus (HIV) infection [4,5] .…”