Incidental hepatic hemangioma
This patient was playing football when she received a left sided body blow. A CT abdomen was performed which showed an incidental hepatic lesion.
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- Liver segment II mass measuring 34 x 30 mm which demonstrates minor nodular peripheral enhancement on the arterial phase, seen to demonstrate further nodular enhancement and filling on portal venous and delayed phases. The mass demonstrates increased attenuation compared with the remainder of the liver on delayed phase. These features would be in keeping with a hemangioma. No evidence to suggest bleeding.
- Liver segment VII low attenuation lesion present measuring 5 mm demonstrated on the portal venous phase but not on the delayed or arterial phases is nonspecific but may also represent a hemangioma.
- Liver segment IVa low attenuation lesion demonstrated on the portal venous phase but not on the arterial or delayed phase. This is nonspecific but may also represent a hemangioma.
1 case question available
Incidental findings during workup for trauma patients is commonplace. A third of patients with incidental findings on CT work up have the potential to cause morbidity if not further evaluated. In one study 1, hepatic lesions were the 6th most common incidental finding during work-up.
The differential diagnosis for this patient's liver lesion is a traumatic lesion vs hemangioma.
Typically, hemangiomas appear hypoattenuating relative to the surrounding liver parenchyma on noncontrast CT 2. With IV contrast, the arterial phase shows peripheral lesion enhancement, followed by centripetal enhancement on the venous phase CT.
In comparison, traumatic hepatic lesions feature the following characteristics 3:
- periportal tracking - hypoattenuation at the right hepatic lobe
- hepatic contusion - irregular hypoattenuating area due to interstitial bleeding
- subcapsular hematoma - biconvex collection, with mass effect on the hepatic parenchyma
- complex laceration - single or multiple linear streaking areas, involving the liver parenchyma
- fragmentation/avulsion of hepatic pedicle - hypoattenuating region, with unmodified enhancement after IV contrast
Case contributed by A/Prof. Pramit Phal.
- 2. Imaging of Atypical Hemangiomas of the Liver with Pathologic Correlation1. Radiographics. 2000;20 (2): 379-397. Radiographics (full text)
- 1. Barrett TW, Schierling M, Zhou C et-al. Prevalence of incidental findings in trauma patients detected by computed tomography imaging. Am J Emerg Med. 2009;27 (4): 428-35. doi:10.1016/j.ajem.2008.03.025 - Pubmed citation
- 3. Romano L, Giovine S, Guidi G et-al. Hepatic trauma: CT findings and considerations based on our experience in emergency diagnostic imaging. Eur J Radiol. 2004;50 (1): 59-66. doi:10.1016/j.ejrad.2003.11.015 - Pubmed citation