Radiographic Findings Celiac angiography reveals displacement of the celiac axis to the left and elevation of the common and proper hepatic arteries (Fig. 1) as well as crowding of the hepatic branches supplying the superior aspect of the right lobe and stretching of vessels over the middle aspect of the liver. The caliber of the celiac axis, common and proper hepatic arteries, and smaller hepatic branches is normal. Multiple punctate areas of contrast material are seen, some of them conglomerate as noted on the venous phase; these areas appear very early in the arterial phase and persist late into the venous phase. There is no evidence of arteriovenous shunting. The portal vein is not seen well, although the splenic vein is easily noted in the left upper quadrant. Differential Diagnosis In assessing hepatic neoplasia, the patient's age, vessel size and tapering, vessel displacement, arteriovenous shunting, vein narrowing and/or occlusion, and neovascularity must be evaluated. One may arbitrarily divide neoplasms affecting the liver into groups based on the age of the patient: those occurring primarily in adult life include hepatocellular carcinoma, hepatocellular adenoma, focal nodular hyperplasia, cholangiocarcinoma, cavernous hemangioma, and metastatic tumor, while hepatoblastoma and hemangioendothelioma affect children and hamartoma and mesenchymal sarcoma may occur in both age groups. Thus the diagnosis of hemangioendothelioma and hepatoblastoma should be excluded in this case on the basis of the patient's age. Cholangiocarcinoma and most metastatic lesions (except for renal, thyroid, carcinoid, some pancreatic tumors, melanoma, and choriocarcinoma) are avascular. When metastatic lesions are hypervascular, contrast accumulation usually does not persist. In addition, metastatic tumors are generally multifocal. This case involves a single large mass containing multiple areas of neovascularity (laking); hence cholangiocarcinoma and metastatic disease would be unusual diagnoses. If the rare hamartoma or mesenchymal sarcoma and focal nodular hyperplasia are excluded, the most logical diagnoses are hepatocellular carcinoma (or adenoma, which frequently has the same angiographic picture) and cavernous hemangioma. Radiological differentiation requires evaluation of vessel size and tapering, vessel displacement, arteriovenous shunting, vein abnormalities, and the type of neovascularity; the presence and type of calcifications on the plain film are not helpful in the differential diagnosis (1). The arteries supplying hepatocellular carcinoma are usually large and do not taper normally; macroscopically, both of these parameters are normal in cavernous hemangioma. Pantoja stated that the arterial branches measuring more than 1 mm in diameter are normal; the smaller vessels are more tortuous and opacify vascular spaces either singly or in clusters (2).