Elevated liver enzymes on routine blood work.
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The ultrasound study shows a subtle 1.5 cm diameter area of mild hyperechogenicity in the right lobe of the liver. Blood flow is seen in this area on the colour Doppler image.
The three CT images were obtained pre-contrast, arterial phase and portal phase. The 1.5 cm lesion seen on ultrasound is of low density on the unenhanced CT image; shows nodular peripheral enhancement during the arterial phase; and fills in completely by the portal phase.
Haemangiomas are the most common benign tumor of the liver occurring most frequently in women. There is no age predilection. A small percentage present with calcifications. Peripheral enhancement with centripetal fill-in is classic for haemangioma but may be seen in other tumours. To conclude that a lesion is a haemangioma on CT, the enhancement must be equal to or greater than that of the aorta, persist with delayed images (enhancement was seen at 10 minutes delay on this study) and show peripheral globular enhancement. MRI is frequently being used to diagnose haemangiomas as signal characteristics can be used in addition to enhancement pattern.