Giant Hemangioma of the Liver

Nina J Abramson, MD
Marla Polger, MD

September 9, 1996

Presentation

Imaging Findings

Spiral computed tomography (CT) of the upper abdomen, obtained immediately after the administration of intravenous contrast (which had been preceded by the administration of oral contrast), shows a low attenuation 14x10x9 cm mass within the lateral segment of the left lobe of the liver. Initial nodular peripheral enhancement forms an incomplete rim (arrows) around the lesion. Note the mass effect on the stomach produced by the enlarged left hepatic lobe.

Images obtained at 10 and 25 minutes delay (respectively) demonstrate progressive centripetal enhancement. The lesion is heterogeneous with areas that are hypo-, iso- and hyperdense to the normal liver parenchyma.

Differential Diagnosis

• Hepatocellular adenoma
• Hepatocellular carcinoma
• Necrotic metastatic tumor

Diagnosis

Discussion

Histologically, cavernous hemangiomas are composed of large vascular channels filled with slowly moving blood and lined by a single layer of endothelial cells. The larger the tumor, the more diverse its internal components tend to be. Giant cavernous hemangiomas may contain areas of hemorrhage, thrombosis, extensive hyalinization, fibrosis, and calcifications.

These features result in heterogeneity in the CT and magnetic resonance (MRI) appearance. Giant hemangiomas often do not achieve complete isodensity on delayed CT images, although they still should demonstrate the characteristic peripheral nodular enhancement. The MRI appearance is that of a well-defined, heterogeneous mass with areas of bright signal on T2-weighted images, cleftlike areas of low intensity on T1, and low intensity internal septae on all pulse sequences.

Variations in size can be extreme. Compared to small, incidentally discovered hemangiomas, giant cavernous hemangiomas (measuring greater than 4 cm) are less common, comprising less than 10% of all hemangiomas. Giant cavernous hemangiomas are more likely to produce symptoms and may bleed when traumatized or grow to a large size. Giant hemangiomas located superficially or adjacent to the inferior vena cava may produce right upper quadrant or epigastric discomfort, probably from hepatomegaly or mass effect on adjacent structures. Rarely, thrombosis occurs in the vascular spaces of the lesion, causing severe abdominal pain. Spontaneous rupture of the liver containing a giant hemangioma has also been reported.

References

2. Taitelbaum G, Hinchey EJ, Herba MJ, Lough J. Giant hemangioma of the liver. Canadian Journal of Surgery 1982 Nov; 25(6): 652-4.

3. Choi BI, Han MC, Park JH, et al. Giant cavernous hemangioma of the liver: CT and MR imaging in 10 cases. American Journal of Roentgenology 1989 Jun; 152(6):1221-6.

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