Atypical Hepatic Hemangioma

Abstract

Hepatic hemangioma is a common incidental finding discovered with abdominal sonography. These lesions consist of collections of atypical blood vessels; structurally, the irregular vessels create blood-filled cystic spaces separated by fibrous connective tissue and endothelial cells. Although these benign lesions typically appear sonographically as small, hyperechoic, and well-circumscribed hepatic masses, atypical hemangiomas make up around one third of hemangiomas diagnosed with sonography. Giant hemangiomas, in particular, are of special significance to the sonographer because their atypical size may create symptoms that mimic other abdominal pathology, such as gallstones or pancreatitis; they may also lead to potentially deadly complications such as rupture, Budd-Chiari syndrome, or Kasabach-Merritt syndrome. If these large vascular lesions become symptomatic, surgical excision may be necessary. A case of hepatic hemangioma is presented that demonstrates the sonographic features of atypical hemangioma and emphasizes the potential of sonography as a high-quality first-line imaging modality.