Calcified cavernous hemangioma of the liver. Review of the literature and report of 13 cases.

Abstract

The purpose of this paper is to report 13 unusual examples of calcified cavernous hemangioma of the liver, roentgeno-logically related to calcified visceral hemangiomas elsewhere in the body, and to record and illustrate the antemortem and postmortem roentgenographic pattern leading to differentiation from other calcified lesions of the liver. The rarity of calcified hemangioma of the liver is attested by the absence of reported examples from the literature. To date, as far as the author could ascertain, the only case recorded in the world literature is that of Aspray (3), whose patient was a sixty-eight-year-old hypertensive housewife in whom an extensive circumscribed shadow in the region of the liver was roentgenographically demonstrated. At autopsy the patient was found to have a calcified cavernous hemangioma. Material This report is based upon 13 cases from 18,195 consecutive autopsy records from the New York Medical College, Metropolitan Medical Center, Flower and Fifth Avenue Hospitals, and Metropolitan and Bird S. Coler Memorial Hospitals. In all but 1 case, the diagnosis of calcified cavernous hemangioma of the liver was made postmortem. The 13 patients included 12 women and 1 man, ranging between sixty-seven and eighty-six years of age. Detailed clinical records were available in 3 cases and adequate documentation was present in 10. Antemortem films of the liver were available in 3 instances and postmortem roentgen studies were carried out in seven cases. Three of the patients were known to have calcification in the region of the liver for eight, nine, and thirteen years, respectively, and 4 for periods of one to seven years. In every instance the roentgen report was coded as possible extrahepatic or intrahepatic involvement or cholelithiasis, except in the case of the male patient, in whom a possible calcified tuberculoma of the liver was considered. In none of the 13 autopsied patients was death attributed to disease of the liver. One patient had associated polyserositis, generalized anasarca, clinical uremia, and hypertension. The cause of death in 7 of the patients was cardiac failure, associated with clinical hypertension; in 3 cerebral hemorrhage associated with clinical hypertension; in 1 patient bilateral pneumonia terminating in sepsis associated with clinical hypertension, and in 1 rupture of an abdominal aneurysm associated with clinical hypertension. To conserve space, only 5 representative cases of the 13 will be described in detail. Case Reports Case I: An 84-year-old white woman was hospitalized because of anemia, periods of exhaustion, and vague abdominal pains. She was emaciated and in respiratory distress. Her heart was enlarged, chiefly the left ventricle. The rhythm was regular, and blood pressure was 190/110. There were fine, moist râles at both lung bases. The liver was palpable, nodular, firm, and not tender. The spleen and kidneys were not palpable or tender.