Giant liver haemangioma

There is often poor agreement in the literature as to the exact definition of what constitutes a giant liver haemangioma.  Some say > 4 cm, others > 6 - 10 cm. Either way they are examples of atypical hepatic haemangiomas ³.

Clinical presentation

Many are asymptomatic, however haemorrhage, thrombosis and mass effect may lead to abdominal fullness and pain. Depending on location and size compressive effects on adjacent structures (biliary dilatation or vascular structures) may also lead to presentation.

Haemorrhage and / or rupture (following trauma / biopsy typically) may also be encountered.

Pathology

May contains areas of central necrosis / liquefaction, haemorrhage, peripheral calcification, fibrosis and thrombosis.

Associations

• hepatic haemangiomatosis

Radiographic features

CT 

Giant haemangiomas may demonstrate similar findings to their smaller relatives, although findings are less consistent.

On non contrast scans the lesions are usually heterogeneous hypo-attenuating masses with marked central areas of low attenuation.

Typical enhancement pattern is of peripheral nodular enhancement that gradually fills centrally and follows aortic density (same as smaller haemangiomas).

Contrast filling may be slow and the central portions may never be demonstrated to fill in. Occasionally they may have no contrast enhancement.

Capsular retraction from scaring may also be seen.

MRI

• T1
  • sharply marginated hypo intense mass
  • cleft like areas of low signal intensity
  • cleft like area may remain hypo intense during enhancement
  • enhancement pattern is otherwise similar to that seen on CT
• T2 - cleft area may be markedly T2 hyper intense

Potential complications

• mass effect on adjacent structures (biliary tree, hepatic vessels)
• Kasabach-Merritt syndrome ⁴ (form of consumptive coagulopathy due to thrombocytopaemia) 
• rupture 

See also

• hepatic haemangioma