Peliosis hepatis: triphasic helical CT and dynamic MRI findings

Abstract

We report the triphasic helical computed tomographic (CT) and dynamic magnetic resonance imaging (MRI) findings in a unique case of biopsy-proven peliosis of the liver. Several reports have described the CT and MRI findings of this entity without specific appearance. This report discusses the usefulness of dynamic helical CT and MRI for the early diagnosis of peliosis.

Unusual cross-sectional imaging findings in hepatic peliosis

“…In the past, hepatic peliosis has been considered a rare entity and most of the published articles on hepatic peliosis were only case reports which supported the opinion that this entity usually represents an incidental autopsy finding in asymptomatic patients; however, presently hepatic peliosis is considered to be a more common finding which may present with hepatic dysfunction, shock from hepatic failure, or even hemorrhage with or without hemoperitoneum from liver rupture and which occasionally may also lead to differential diagnostic problems if detected by CT or MR in a patient with the above-mentioned conditions [1,2,3,4,5,6,7,8,9,10].…”

“…Hepatic peliosis is often associated with chronic wasting diseases, such as tuberculosis and malignancies, but it has also been reported in patients treated long-term with anabolic steroids, oral contraceptives, hormones, or azathioprine with generally observed regression of the liver lesions after discontinuation of treatment with these agents [2,3,4,5,6]. Recently, even a bacterial causative agent (Rochalimea hensela) has been reported as a cause of HIV-related hepatic peliosis which typically also shows regression after appropriate antibiotic treatment with erythromycin [7,8,9].…”

CT of Nonneoplastic Hepatic Vascular and Perfusion Disorders

“…At unenhanced CT, the lesions are typically hypoattenuating (30,32,33). At contrast-enhanced CT, a variable enhancement pattern is seen: In the arterial phase, the lesions may appear hypoattenuating in relation to the liver and progressively become hyperattenuating.…”

“…Although the exact origins of this disorder are unknown, peliosis hepatis may be secondary to chronic wasting diseases (eg, tuberculosis, leprosy), various malignancies (eg, hepatocellular (32,34) or centrifugal (Fig 14) (33) enhancement on portal venous phase images without mass effect on adjacent hepatic vessels. In the delayed phase, diffuse increased attenuation may be seen (33). Thrombosed cavities resemble nonenhancing nodules and may simulate metastases or abscesses (31).…”

Peliosis and gummatous syphilis of the liver: A case report

“…Peliosis hepatis is a rare kind of benign vascular disorder characterized by widespread blood-filled cystic cavities in the liver [1] . Occasionally, the lesion mimics tumor.…”