Case History: 60-year-old female with complaint of right hypochondriac pain associated with asthenia and decreased appetite for one month.
On examination, lower margin of liver was palpable below right sub-costal margin.
Figure 1. On ultrasound, the lesion in the liver appears iso to hypoechoic in echotexture.On color Doppler study, the peak systolic velocity of hepatic artery measures 48 cm/second (
Figure 2. On plain CT axial image, the lesions appear hypo-dense to surrounding liver parenchyma. On CECT scanning, the lesions appear hypodense with peripheral enhancement (yellow arrow), which progresses centripetally so much so that lesions become iso-dense to surrounding liver (white arrow).
Figure 3. On MRI, axial image, liver shows multiple lesions of variable sizes, which appear hypointense on T1 and hyperintense on axial and coronal image on T2, which shows capsular retraction (white arrow). The lesions appear more intense on T2+T2 fat sat image in comparison to T2 image.
Figure 4. On Gadolinium-enhanced MRI, axial sections of T1 fat sat images, lesions show enhancement pattern similar to CECT (ie, peripheral enhancement with centripetal filling).
Figure 5. On Gadolinium-enhanced MRI further delayed imaging up to 2 hours, progressive centripetal filling without contrast wash out.
Diagnosis: Hepatic hemangio-endothelioma
Lesions in the liver were hypodense on T1, hyperintense on T2 pulse sequences and more intense on T2+T2 fat sat in comparison to T2 images with capsular retraction in large lesions.
Hepatic hemangio-endothelioma is a rare, atypical hemangioma, usually diagnosed incidentally.
Treatment of choice is surgical resection or liver transplantation.
