Hepatic hemangioma - flash filling

Case contributed by Avni K P Skandhan
Diagnosis almost certain


Evaluation of a chronic pelviureteric junction (PUJ) obstruction.

Patient Data

Age: 80 years
Gender: Male

In the arterial phase there is a brilliantly, homogenously enhancing lesion in left lobe of liver, which becomes nearly isodense to liver parenchyma on the delayed phase, suggestive of a flash filling hemangioma. No secondary evidence of chronic liver disease. Ultrasound correlation shows a hyperechoic lesion.

Gross hydronephrosis with thinning of renal parenchyma noted in right kidney. There is abrupt narrowing of the pelvicalyceal system at PUJ. However both kidneys show prompt contrast uptake. Contrast enters the pelvicalyceal system and exits through the ureter into the bladder. This suggests a partial obstruction, possibly due to a stricture at the pelviureteric junction (PUJ).

Few small calcifications noted in liver parenchyma, possibly old granulomatous lesions. A small hypodense lesion is seen in the left lobe of liver.


Case Discussion

Normally the classical enhancement pattern of hemangiomas is a gradual centripetal, nodular filling of the lesions. However certain small hemangiomas may show fast and homogeneous enhancement on the arterial phase itself, thus the name "flash filling" hemangioma.

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