One stop shop approach for the diagnosis of liver hemangioma

Abstract

Hepatic hemangioma is usually detected on a routine ultrasound examination because of silent clinical behaviour. The typical ultrasound appearance of hemangioma is easily recognizable and quickly guides the diagnosis without the need for further investigation. But there is also an entire spectrum of atypical and uncommon ultrasound features and our review comes to detail these particular aspects. An atypical aspect in standard ultrasound leads to the continuation of explorations with an imaging investigation with contrast substance [ultrasound/ computed tomography/or magnetic resonance imaging (MRI)]. For a clinician who practices ultrasound and has an ultrasound system in the room, the easiest, fastest, non-invasive and cost-effective method is contrast enhanced ultrasound (CEUS). Approximately 85% of patients are correctly diagnosed with this method and the patient has the correct diagnosis in about 30 min without fear of malignancy and without waiting for a computer tomography (CT)/MRI appointment. In less than 15% of patients CEUS does not provide a conclusive appearance; thus, CT scan or MRI becomes mandatory and liver biopsy is rarely required. The aim of this updated review is to synthesize the typical and atypical ultrasound aspects of hepatic hemangioma in the adult patient and to propose a fast, non-invasive and cost-effective clinical-ultrasound algorithm for the diagnosis of hepatic hemangioma.

Transarterial embolization for rare spontaneous subacute intratumoral hemorrhage of hepatic hemangioma: a case report and literature review

“…In the delayed phase, the entire tumor is uniformly enhanced ( 23 ). In addition, when the tumor is complicated with hemorrhage, the hematoma is hyperdense ( 5 , 24 , 25 ). In contrast, MRI is more valuable because the hematoma has characteristic findings, i.e., high signal on T1WI and T2WI ( 25 ).…”

ACG Clinical Guideline: Focal Liver Lesions

“…The typical sonographic appearance of a cavernous hemangioma is a homogeneous hyperechoic observation with posterior acoustic enhancement, usually seen in hemangiomas less than 3 cm in size. Hemangiomas tend to be "avascular" on color Doppler imaging, which is related to slow flow within the large vascular spaces within the tumor (127,130,131).…”

“…Ultrasound is often the first imaging modality to detect an incidental hemangioma and can sometimes be diagnostic enough not to require further evaluation (127). However, in most instances, further evaluation with cross-sectional imaging is necessary for diagnosis confirmation, especially when a suspected hemangioma is seen in a patient with hepatitis B, cirrhosis, or underlying history of malignancy.…”

Comprehensive review of imaging modalities for diagnosis and characterization of focal liver lesions

“…They can be distinguished from the liver tissue by a brighter band distally, produced by decreased attenuation of the ultrasound waves through their fluid compared to the liver texture [1] . Haemangiomas are typically show as homogeneously solid echogenic masses, with possible increased enhancement of the mass in a patient without the risk of HCC or metastases [32] . On a Color Doppler ultrasound, they are hypovascular and rarely show weak venous signals [33] .…”