Cavernous hemangioma of the liver - Color Ultrasound
Title: Color Ultrasound - Cavernous hemangioma of the liver
Diagnosis: Cavernous hemangioma of the liver
Chapter: Liver & Spleen
Clinical Presentation: Postoperative ultrasound for aspecificabdominal pain.
Comment: Cavernous hemangiomas are the most common benign tumorsof the
liver. The sonographic appearance of hemangiomas vary. Themost typical appearance is
that of a small(<3 cm), well-defined,homogenous and hyperechoic nodule. Larger lesions
tend to beheterogenous with central hypoechoic foci reflecting collagen scarsor large
vascular spaces or both. Blood flow is very slow withinthe hemangioma and at present
flow is not detectable even withPower Doppler although this issue remains controversial.
Thefinding of globular peripheral enhancement during contrast enhancedCT is a strong
indicator that the lesion is a cavernous hemangioma.Complete isodense fill in of the lesion
on a delayed scan also isin favor of a hemangioma. On MR hemangiomas demonstrate
markedhyperintensity on a T2 weighted scan. On a Gadolinium chelateenhance MR scan
hemangioma show an enhancement pattern which issimilar to that seen with CT:
progressive centripetal enhancementand persistent homogenous enhancement.
Hemangiomas are typicallyhyperintense on T1 w Endorem enhanced scan.
Description: The sonogram shows a large focal mass of the rightlobe of the liver.
It is heterogeneous and has scalloping marginswhich are partly hypoechoic. Moreover, a
focus of calcification isseen within the mass. The CDFI did not show any flow within
thelesion but demonstrated normal vessels that ran through the masswithout distortion or
stenosis. A CT was performed due to theatypical appearance of this hemangioma. This
study confirmed thediagnosis of carvernous hemangioma by showing the typical
globularperipheral enhancement and late isodense fill-in.
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