Giant hepatic haemangioma

Abstract

A 52-year-old woman presented to her general practitioner with a 2 month history of upper abdominal discomfort. There was no significant past medical or surgical history and examination of the abdomen was unremarkable without hepatosplenomegaly.She was referred for an abdominal ultrasound, which found an 8.3-cm echogenic lesion in the right lobe of the liver. Contrast-enhanced computed tomography (CT) and Tc-99 m-labelled red blood cell scintigraphy of the liver were requested for further evaluation of a suspected hepatic haemangioma.The contrast-enhanced CT scan showed a low density lesion in segment 7 of the liver, with vascular characteristics compatible with a hepatic haemangioma (Fig. 1). The 4-h delayed Tc-99 m-labelled red blood cell single photon emission computed tomography (SPECT) scan demonstrated progressive red blood cell accumulation by the lesion when compared to the early images (not shown), a sine qua non of hepatic haemangioma. Fusion of the anatomic (CT) and physiologic (SPECT) images is shown in Figure 1.Hepatic haemangiomas are the most common benign tumour of the liver, being present in 2% of the population. 1 They are frequently asymptomatic and incidentally discovered at imaging, presenting a diagnostic challenge as they can occasionally mimic other benign and malignant hepatic lesions, such as focal nodular hyperplasia, hepatic adenoma, hepatocellular carcinoma and hepatic metastasis.Lesions measuring more than 4 cm in diameter are known as 'giant haemangiomas' and often cause symptoms such as vague abdominal distention and pain. 2 Complications include compression of adjacent structures, rupture, acute thrombosis or consumptive coagulopathy (Kasabach-Merritt syndrome). 3Contrast-enhanced CT is reported to have a sensitivity of 88% and a specificity of 84-100% for differentiating hepatic haemangiomas from hypervascular metastases. 4 In comparison, Tc-99 m-labelled red blood cell SPECT has a sensitivity of 97%, specificity of 83% and accuracy of 96% in the investigation of suspected hepatic haemangiomas larger than 1 cm. 5 Lesion characterisation and localisation with contrastenhanced CT should be performed prior to scintigraphy for optimal localisation, and to avoid non-contributory scintigraphic findings for lesions less than 1 cm, which are beyond the limit of resolution of the gamma camera.Fusion of SPECT/CT where possible might be useful for definite localisation, especially of suspected haemangiomas located near regions with high vascularity. 6 REFERENCES 1 Federle MP, Brancatelli G, Blachar A. Hepatic hemangioma. N Engl J Med 2000; 343: 368-9. 2 Kaido T, Imamura M. Images in clinical medicine. Giant hepatic hemangioma. N Engl J Med 2003; 349: e19. 3 Vilgrain V, Boulos L, Vullierme MP, Denys A, Terris B, Menu Y. Imaging of atypical hemangiomas of the liver with pathologic correlation. Radiographics 2000; 20: 379-97. 4 Leslie DF, Johnson CD, MacCarty RL, Ward EM, Ilstrup DM, Harmsen WS. Single-pass CT of hepatic tumors: value of globular enhancement in distinguishing hemangiomas from ...

Recurrent Giant Hemangioma Causing Severe Respiratory Distress

“…Kasabach-Merritt syndrome, with consumptive coagulopathy resulting from sequestration and destruction of platelets within the hemangioma may also occur [8]. Complications include compression of adjacent abdominal structures, rupture, and acute thrombosis [9]. Surgical resection provides the only consistently effective method of treatment and is indicated for symptomatic lesions, rapidly enlarging masses, rupture, profound thrombocytopenia, and an uncertain diagnosis [10].…”