EURORAD ESR

Case 12684

Pedunculated liver haemangioma: a challenging imaging diagnosis with potential danger

Author(s)
Tonolini Massimo, MD1; Rizzi Andrea, MD2; Gambitta Pietro, MD3

(1) Department of Radiology
(2) Department of Surgery
(3) Department of Digestive Endscopy
"Luigi Sacco" University Hospital
Via G.B. Grassi 74
20157 Milan, Italy
Email:mtonolini@sirm.org
 
Patient
male, 80 year(s)
 
 
  • Figure 1
    Initial multidetector CT
     

    Unenhanced axial (a) and coronal (b) images detected a 7x3.5cm well-demarcated ovoid mass (arrowheads), moderately inhomogeneous with a few linear calcifications (thin arrows), located ventrally to the spleen and...

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Haemangioma;

    Unenhanced axial (a) and coronal (b) images detected a 7x3.5cm well-demarcated ovoid mass (arrowheads), moderately inhomogeneous with a few linear calcifications (thin arrows), located ventrally to the spleen and...

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Haemangioma;

    After intravenous contrast, arterial- (c,d) and venous-phase (e,f) acquisitions showed localized, eccentrically located foci of progressive enhancement (arrows). Conversely, most of the mass did not enhance. Note...

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Haemangioma;

    After intravenous contrast, arterial- (c,d) and venous-phase (e,f) acquisitions showed localized, eccentrically located foci of progressive enhancement (arrows). Conversely, most of the mass did not enhance.

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Haemangioma;

    After intravenous contrast, arterial- (c,d) and venous-phase (e,f) acquisitions showed localized, eccentrically located foci of progressive enhancement (arrows). Conversely, most of the mass did not enhance. Note...

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Haemangioma;

    After intravenous contrast, arterial- (c,d) and venous-phase (e,f) acquisitions showed localized, eccentrically located foci of progressive enhancement (arrows). Conversely, most of the mass did not enhance. Note...

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Haemangioma;

    Delayed (5 minutes) phase acquisition showed persistent, more extensive enhancement of the medial portion of the mass (arrows). Note extrinsic compression of the stomach (+).

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Haemangioma;

    Delayed (5 minutes) phase acquisition showed persistent, more extensive enhancement of the medial portion of the mass (arrows). Note extrinsic compression of the stomach (+).

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Haemangioma;
     
     
  • Figure 2
    Unenhanced upper abdominal MRI
     

    Axial T1- (a) and T2-(b) weighted images confirmed a well-demarcated mass ventral to the spleen, extrinsically compressing the stomach (+) without signs of infiltration, with intermediate T1 and moderately high T2...

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Haemangioma;

    Axial T1- (a) and T2-(b) weighted images confirmed a well-demarcated mass ventral to the spleen, extrinsically compressing the stomach (+) without signs of infiltration, with intermediate T1 and moderately high T2...

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Haemangioma;

    Coronal T2-weighted images confirmed a well-demarcated mass (arrowheads) extrinsically compressing the stomach (+) without signs of infiltration, with moderately high T2 signal intensity, a few strongly hyperintense...

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Haemangioma;

    Coronal T2-weighted images confirmed a well-demarcated mass (arrowheads) extrinsically compressing the stomach (+) without signs of infiltration, with moderately high T2 signal intensity, a few strongly hyperintense...

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Haemangioma;
     
     
  • Figure 3
    Emergency multidetector CT after EUS-guided biopsy
     

    One hour after EUS-guided biopsy, unenhanced CT acquisition showed appearance of massive hyperattenuating effusion (*) consistent with haemoperitoneum.

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Endoscopy; Special Focus: Haemorrhage;

    Arterial- (b,c) and venous (d,e) phase acquisitions confirmed massive haemoperitoneum (*). The left-sided mass showed increasing size and perfusion foci (arrows) consistent with lesional active bleeding.

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Endoscopy; Special Focus: Haemorrhage;

    Arterial- (b, c) and venous (d,e) phase acquisitions confirmed massive haemoperitoneum (*). The left-sided mass showed increasing size and perfusion foci (arrows) consistent with lesional active bleeding.

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Endoscopy; Special Focus: Haemorrhage;

    Arterial- (b, c) and venous (d,e) phase acquisitions confirmed massive haemoperitoneum (*). The left-sided mass showed increasing size and perfusion foci (arrows) consistent with lesional active bleeding.

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Endoscopy; Special Focus: Haemorrhage;

    Arterial- (b,c) and venous (d,e) phase acquisitions confirmed massive haemoperitoneum (*). The left-sided mass showed increasing size and perfusion foci (arrows) consistent with lesional active bleeding.

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Endoscopy; Special Focus: Haemorrhage;
     
     
  • Figure 4
    Retrospective focused MIP reformations on initial CT (Fig.1)
     

    Retrospectively, focused maximum intensity projection (MIP) reformatted images of the initial multidetector CT identified a very thin stalk (thin arrows) connecting the left-sided mass (*) abutting the stomach (+) to...

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Haemangioma;

    Retrospectively, focused maximum intensity projection (MIP) reformatted images of the initial multidetector CT identified a very thin stalk (thin arrows) connecting the left-sided mass (*) abutting the stomach (+) to...

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Haemangioma;
     
     
Unenhanced axial (a) and coronal (b) images detected a 7x3.5cm well-demarcated ovoid mass (arrowheads), moderately inhomogeneous with a few linear calcifications (thin arrows), located ventrally to the spleen and compressing the stomach (+) medially.
 
Unenhanced axial (a) and coronal (b) images detected a 7x3.5cm well-demarcated ovoid mass (arrowheads), moderately inhomogeneous with a few linear calcifications (thin arrows), located ventrally to the spleen and compressing the stomach (+) medially.
 
After intravenous contrast, arterial- (c,d) and venous-phase (e,f) acquisitions showed localized, eccentrically located foci of progressive enhancement (arrows). Conversely, most of the mass did not enhance. Note extrinsic compression of the stomach (+).
 
After intravenous contrast, arterial- (c,d) and venous-phase (e,f) acquisitions showed localized, eccentrically located foci of progressive enhancement (arrows). Conversely, most of the mass did not enhance.
 
After intravenous contrast, arterial- (c,d) and venous-phase (e,f) acquisitions showed localized, eccentrically located foci of progressive enhancement (arrows). Conversely, most of the mass did not enhance. Note extrinsic compression of the stomach.
 
After intravenous contrast, arterial- (c,d) and venous-phase (e,f) acquisitions showed localized, eccentrically located foci of progressive enhancement (arrows). Conversely, most of the mass did not enhance. Note extrinsic compression of the stomach (+).
 
Delayed (5 minutes) phase acquisition showed persistent, more extensive enhancement of the medial portion of the mass (arrows). Note extrinsic compression of the stomach (+).
 
Delayed (5 minutes) phase acquisition showed persistent, more extensive enhancement of the medial portion of the mass (arrows). Note extrinsic compression of the stomach (+).
 
Axial T1- (a) and T2-(b) weighted images confirmed a well-demarcated mass ventral to the spleen, extrinsically compressing the stomach (+) without signs of infiltration, with intermediate T1 and moderately high T2 signal intensity.
 
Axial T1- (a) and T2-(b) weighted images confirmed a well-demarcated mass ventral to the spleen, extrinsically compressing the stomach (+) without signs of infiltration, with intermediate T1 and moderately high T2 signal intensity.
 
Coronal T2-weighted images confirmed a well-demarcated mass (arrowheads) extrinsically compressing the stomach (+) without signs of infiltration, with moderately high T2 signal intensity, a few strongly hyperintense internal foci (thin arrows).
 
Coronal T2-weighted images confirmed a well-demarcated mass (arrowheads) extrinsically compressing the stomach (+) without signs of infiltration, with moderately high T2 signal intensity, a few strongly hyperintense internal foci (thin arrows).
 
One hour after EUS-guided biopsy, unenhanced CT acquisition showed appearance of massive hyperattenuating effusion (*) consistent with haemoperitoneum.
 
Arterial- (b,c) and venous (d,e) phase acquisitions confirmed massive haemoperitoneum (*). The left-sided mass showed increasing size and perfusion foci (arrows) consistent with lesional active bleeding.
 
Arterial- (b, c) and venous (d,e) phase acquisitions confirmed massive haemoperitoneum (*). The left-sided mass showed increasing size and perfusion foci (arrows) consistent with lesional active bleeding.
 
Arterial- (b, c) and venous (d,e) phase acquisitions confirmed massive haemoperitoneum (*). The left-sided mass showed increasing size and perfusion foci (arrows) consistent with lesional active bleeding.
 
Arterial- (b,c) and venous (d,e) phase acquisitions confirmed massive haemoperitoneum (*). The left-sided mass showed increasing size and perfusion foci (arrows) consistent with lesional active bleeding.
 
Retrospectively, focused maximum intensity projection (MIP) reformatted images of the initial multidetector CT identified a very thin stalk (thin arrows) connecting the left-sided mass (*) abutting the stomach (+) to the left liver lobe (^).
 
Retrospectively, focused maximum intensity projection (MIP) reformatted images of the initial multidetector CT identified a very thin stalk (thin arrows) connecting the left-sided mass (*) abutting the stomach (+) to the left liver lobe (^).
 
 
 
Home Search Sections Teaching Cases History FAQ Case Archives Contact Login Disclaimer Imprint Switch to MOBILE version
View desktop version