Hepatic hemangioma

Contributors: Cafer Zorkun M.D., PhD.

Overview
Hepatic hemangioma is the most common primary liver tumor.

Incidence
Ranges from 0.4-20% of the population. M:F = 1:5

Pathogenesis

 * Arise from the endothelial cells that line the blood vessels and consists of multiple, large vascular channels lined by a single layer of endothelial cells and supported by collagenous walls.
 * They may be associated with focal nodular hyperplasia.
 * May be associated with Kasabach-Merritt syndrome: Hemolytic anemia and consumptive coagulopathy

Diagnosis
They are frequently asymptomatic and incidentally discovered at imaging, surgery, or autopsy.

Ultrasonography

 * Echogenic
 * Homogenous

Computed Tomography

 * Noncontrast: Hypointense to liver
 * Portal venous enhancement: Peripheral nodular enhancement
 * Delayed enhancement: Lesion fills in the contrast

MRI

 * T2 hyperintense
 * Portal venous enhancement: Peripheral nodular enhancement
 * Delayed enhancement: Lesion fills in the contrast

Scintigraphy

 * Tc99-labeled red blood cells show decreased activity on early dynamic images and increased activity on delayed images (i.e. 1-2 hours).
 * Only sensitive for larger lesions.

Diagnostic Findings
Images courtesy of RadsWiki

References & Additional Resources

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