Unique MR Findings in a Case Series of Two Symptomatic Patients with Peliosis Hepatis

Drew Pierce,Christopher S Davis,Zarine K Shah,Paul M Bloomston

doi:10.4236/ojrad.2014.41010

Abstract

Purpose: The aim of this report is to describe the unusual MR imaging characteristics observed in two patients with biopsy-proven peliosis hepatis. Imaging findings using gadoxetate disodium (Eovist) as the contrast agent in a patient with peliosis hepatis are presented for the first time. Methods: This is a retrospective review of the MRI findings in two patients reviewed independently by two specialized abdominal imaging radiologists. The radiological findings were correlated with clinical history and histopathology. Results: Peliosis hepatis is a rare clinical and radiological entity that is often a diagnostic dilemma due to its non-specific clinical characteristics. Unusual imaging characteristics in this rare entity make diagnosis even more challenging. Conclusions: Improved understanding of the imaging characteristics of peliosis hepatis may prevent unnecessary and potentially dangerous biopsies in select patients with peliosis hepatis. This requires a high index of suspicion for practicing radiologists due to the rarity of this disease.

Highlights

Peliosis hepatis is an uncommon clinical entity characterized by irregular blood-filled cavities in the liver
Two pathologic categories of peliosis hepatis have been described, the “phlebectatic” type, in which the cavities are lined by endothelium, and the “parenchymal” type, in which the cavities are lined by necrotic hepatocytes [1]
Peliosis hepatis is a rare but potentially life-threatening clinical entity. It is a rare entity, peliosis hepatis should be kept in the differential diagnosis for all hepatic lesions of unclear etiology

Summary

Introduction

Peliosis hepatis is an uncommon clinical entity characterized by irregular blood-filled cavities in the liver. Since the term was coined by Schoenlank in 1916, only case reports have been published, leaving the condition poorly understood. Liver failure and life-threatening intra-abdominal hemorrhage are potential complications [1], [2]. Diagnosis of peliosis hepatis is often delayed due to its rarity and vague clinical manifestations [3].

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