Hepatic hemangiomas after embolization

Case contributed by Vinay V Belaval

Presentation

Patient with treated hepatic hemangiomas came with vague dull-aching generalized abdominal pain.

Patient Data

Age: 60 years
Gender: Female

Triphasic CECT abdomen

ct

Axial images of a triphasic contrast study of abdomen done in 2016 show well defined peripheral hypodense lesion in segment VI of liver with peripheral puddling of contrast in arterial phase and progressive centripetal filling-in in portal venous and delayed venous phases measuring 5.9 x 3.7 x 6.0 cm (AP x TR x CC) - consistent with hemangioma. There is capsular retraction overlying the lesion. Non-enhancing central cystic/ necrotic areas are noted within the lesion.

Similar morphology lesion is noted in segment VII of liver measuring 2.3 x 3.7 x 3.3 cm (AP x TR x CC) - consistent with hemangioma.

Post-embolization triphasic CECT abdomen

ct

Patient underwent selective embolization with PVA particles in 2016.

Triphasic contrast study of abdomen in June, 2020 showed hypodense lesions in segment VI and VII of liver with minimal or absent enhancement in all three phases. Segment VI lesion measures 3.4 x 2.9 x 2.9 cm (AP x TR x CC) and segment VII lesion measures 0.9 x 1.9 x 1.0 cm. 

These lesions as compared to 2016 study, show reduction in size and near-complete resolution of progressive contrast enhancement- representing successful embolization. No calcifications are seen.

Case Discussion

Giant subcapsular hepatic hemangiomas carry a risk of rupture. These can be treated with selective embolization with successful outcomes, as in our case.

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