Flash filling hepatic venous malformation

Flash filling hepatic venous malformations, also known as flash filling hepatic haemangiomas, are a type of atypical hepatic venous malformation (haemangioma), which due to its imaging features often raises the concern of a malignant process rather than a benign one. 

It is important to note that according to newer nomenclature (ISSVA classification of vascular anomalies) these lesions are merely known as slow flow venous malformations. Having said that it is probably helpful in reports to include the word 'hemangioma' as this term is ubiquitous in the literature and most familiar to many clinicians. The remainder of this article uses the terms 'flash filling hemangioma' and 'flash filling hepatic venous malformation' interchangeably. 

They may account for 16% of all hepatic haemangiomas 3.

Being a subtype of hepatic haemangioma, it is also composed of dilated endothelial lined vascular channels and fibrous stroma.

Most are small in size (< 2cm). 

Ultrasound

On ultrasound, most are hyperechoic - same as the typical haemangiomas. 

CT

On CT, these lesions are normally iso- to hypo-dense on unenhanced scans. There is a quick, brilliant and homogeneous enhancement of the lesion in the arterial phase itself, hence the name "flash filling". In the rest of the phases it retains the contrast and remains isodense to the adjacent vascular pool. 

MRI
  • T1: hypointense 
  • T2: markedly hyperintense
  • C+ (Gd): prompt enhancement but no washout
Other general features

At times the venous matrix of these haemangiomas may develop phleboliths, which when recognised should be promptly associated with haemangioma. 

Due to the atypical feature of quick, brilliant arterial phase enhancement, these lesions have to be differentiated from:


Vascular tumours and malformations
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Article Information

rID: 25580
Section: Pathology
Tag: refs
Synonyms or Alternate Spellings:
  • Flash filling hepatic haemangiomas
  • Flash filling hepatic haemangiomata
  • Flash filling hepatic hemangioma
  • Flash fill hepatic haemangioma
  • Flash filling haemangioma
  • Flash fill hemangioma
  • Flash fill hepatic hemangioma
  • Rapid filling hepatic haemangioma
  • Rapildly filling hepatic haemangioma
  • Flash filling hepatic haemangioma
  • Flash filling hepatic venous malformations

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