Hepatic haemangioma

Case contributed by Dr Jan Frank Gerstenmaier

Presentation

This patient with a history of pancreatitis had an ultrasound during which a hypoechoic lesion was seen in the liver.

Patient Data

Age: 58
Gender: Female
Modality: CT

In the lateral aspect of the right lobe of the liver inferiorly there is a 1.5 cm indiameter lesion that behaves in a fashion of a cavernous haemangioma. The liver is otherwise normal in appearance.

Modality: MRI

There is mild pancreatic atrophy but the main pancreatic duct is not dilated. No focal pancreatic lesion is seen. Previous cholecystectomy. The biliary tree is unremarkable. There are no filling defects to suggest intraductal calculus.

There is diffuse fatty infiltration of the liver, and in addition there is a geographic area of focal fat infiltration posteriorly in segments 4 A and 4 B.

In segment 6 of the liver, there is a 1.8 centimetre cavernous haemangioma. In segment 8, there is a 5 mm probable haemangioma.

Tiny T2 hyperintensities in segments 7, 8, 2 and 4 likely represent small cysts.

There is a 1.5 centimetre lipid rich benign adrenal adenoma. The right adrenal gland appears normal.

Modality: Ultrasound

The liver demonstrates increased echogenecity in keeping with moderate fatty infiltration.

Within segment 5/6 there is a 1.9 x 1.3 cm heterogenous lesion which demonstrates internal vascularity and feeding vessel entering the centre of the lesion.

Modality: Ultrasound

A diffuse increase in echogenicity of the hepatic parenchyma is consistent with fatty change. 15 mm mildly hypoechoic subcapsular lesion in segment 5/8. Gallbladder contains sludge and a 5 mm polyp or calculus. Common bile duct is not dilated, measuring 5mm at the porta hepatis.

Case Discussion

The liver haemangioma has atypical ultrasound appearances as a hypoechoic lesion. There is increased echointensity due to hepatic steatosis which at least partly explains this. The appearances at CT and MR are typical. 

Incidental adrenal adenoma.

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Case Information

rID: 29949
Case created: 6th Jul 2014
Last edited: 8th Jan 2016
Inclusion in quiz mode: Included

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