Presentation
Presented with several weeks of bloating and constipation. Imaged to rule out mass or other cause of mechanical obstruction.
Patient Data
Imaging modality:
Single phase quad-bolus IV contrast enhanced polychromatic dual energy (SPECTRAL) CT reconstructed with monoE40 photon.
Imaging findings:
Numerous peripherally arranged lesions throughout the liver, largest in the left hepatic lobe measuring 73 x 96 x 53 mm with approximately ten other similar lesions scattered throughout the liver demonstrating peripheral puddling of contrast.
Additional findings, not discussed further include three low density foci over the spleen and a right renal cyst.
Case Discussion
Hepatic hemangiomas are congenital, non-neoplastic vascular malformations within the liver, typically an incidental finding on imaging. The majority of hepatic hemangiomas are cavernous, and range in size from 2-10 cm. They are isodense to blood 1.
Dual-energy (spectral) CT uses the datasets acquired from two different x-ray spectra, allowing for the detection and quantification of iodine on CT images which in turn corresponds to vascularization 2. While no studies have looked at improved diagnostic sensitivity and specificity of hepatic hemangiomas imaged with dual energy CT, conspicuity of the vascular distribution is theoretically improved. Distinct margins with peripheral pooling can be seen clearly in this case.
Management:
The lesions are asymptomatic and very slow growing. No active management is required unless the hemangioma should rupture, form an abscess, or enlarge to the point it causes symptoms.
Case courtesy of Dr Zane Sherif.
Unable to process the form. Check for errors and try again.