Flash filling hepatic hemangiomas are a type of atypical hepatic hemangioma that shows a quick homogeneous enhancement in the arterial phase and retains the contrast and remains isodense to the adjacent vascular pool in the rest of the phases. This is just a contrast fade and not a washout as the lesion never presents hypodensity relative to the hepatic parenchyma.

Hepatic hemangiomas are typically hyperechoic lesions on ultrasound. However, in a small proportion (10%) they are hypoechoic, which may be due to a background of hepatic steatosis, where the liver parenchyma itself is of increased echogenicity.

Ultrasound contribution by Dr. Shaimaa Hussain