Presentation
Abdominal pain.
Patient Data
Multiple hypodense heterogeneous lesions throughout the liver.
Heterogeneous masses throughout the liver, being slightly hypodense on the non-contrast CT with enhancement on portal venous and progressive enhancement on delayed phases. Some of the masses are centrally hypodense.
Multifocal T2 hyperintense lesions throughout the liver parenchyma involving the right and left lobes varying in size from 3 mm to 3.5 cm. The largest lesion is present within the medial aspect of segment 5.
The lesions display a heterogenous early arterial enhancement with some lesions enhancing centrally and others enhancing peripheral with a centripetal pattern of enhancement. On the portal venous phase and delayed three-minute postcontrast sequences the lesions show progressive enhancement and development of a pseudocapsule on the three-minute delayed sequence. No documented contrast uptake within the lesions on the hepatocellular phase of imaging.
No intrahepatic or extrahepatic biliary duct dilatation. Portal and hepatic veins remain patent. No focal splenic lesion.
T1/T2 hyperintense lesions measuring 8 mm within T10 and L3 likely represent hemangiomas rather than bony metastases. Multilevel spinal degenerative change.
Case Discussion
Hepatic angiosarcoma are rare primary liver tumors. They typically have a multifocal appearance of vascular, progressively enhancing masses.
Case courtesy of Dr Beng Ghee Lim and A.Prof Damien Stella, consultant radiologists, The Royal Melbourne Hospital.
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