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Hepatic Cavernous Hemangioma
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Author(s) :
Danilo Sirigu, MD
 
Presentation A 39-year-old woman presented with a history of abdominal distention and recurrent abdominal pain.
 
 
Caption: Real-time Imaging of the Upper Abdomen
Description: Abdominal sonography revealed a large mass approximately 8cm x 6 cm in diameter with heterogeneous echo pattern in 1 and 4a liver segments. Color Doppler shows no flow inside the mass.
 
 
Caption: Contrast Enhanced Ultrasound (CEUS)
Description: After contrast agent intravenous administration, the lesion demonstrates peripheral enhancement in arterial phase with slow and incomplete filling in venous phase.
 
 
 
Caption: Real-time Imaging of the Upper Abdomen
Description: Abdominal sonography revealed a large mass approximately 8cm x 6 cm in diameter with heterogeneous echo pattern in 1 and 4a liver segments. Color Doppler shows no flow inside the mass.
 
Differential Diagnosis Hepatic Adenoma
Hepatocellular Carcinoma
Metastases  
 
Final Diagnosis Hepatic Cavernous Hemangioma
 
Discussion Cavernous hemangioma is the most common primary liver tumor; its occurrence in the general population ranges from 0.4-20%, as reported by Karhunen in an autopsy series. Usually, cavernous hemangiomas occur as solitary lesions; however, they may be multiple in as many as 50% of patients.  It typically occurs in women.
 
PATHOLOGY:
Histologically, the tumor is thin walled. Its vascular spaces are lined by a single layer of endothelial cells that are separated by fibrous septa.  No bile ducts are found in the tumor.  When cavernous hemangioma enlarges to more than 10 cm in diameter it is referred to as Giant Hemangioma and typically develops a more complex ultrasound appearance due to areas of fibrosis, necrosis and hemorrage within the tumor.

CLINICAL ISSUES:
Usually asymptomatic ; hepatomegaly and abdominal pain may be present in giant hemangioma.

PROGNOSIS:
Rare complication : rupture and abscess formation.

TREATMENT:
Follow-up.
Surgical resection in symptomatic large lesions  and  Kasabach-Merritt syndrome
( trombocytopenia and intravascular coagulation).
 
Case References
  1. Karhunen PJ. Benign hepatic tumours and tumour like conditions in men. J Clin Pathol. Feb 1986;39(2):183-8
  2. Mergo PJ, Ros PR. Benign lesions of the liver. Radiol Clin North Am. Mar 1998;36(2):319-31
  3. Srinivasa Prasad, MD, Dushyant Sahani, MD, Sanjay Saini, MD Cavernous Hemangioma, Liver www.emedicine.com/radio/TOPIC136.htm
  4. O. Catalano, A. Nunziata, R. Lobianco, and A. Siani. Real-Time Harmonic Contrast Material-specific US of Focal Liver Lesions.  RadioGraphics, March 1, 2005; 25(2): 333 - 349.