Unusual cross-sectional imaging findings in hepatic peliosis

Hepatic peliosis is a rare entity that represents focal, multifocal, segmental, or diffuse dilatation of liver sinusoids. Hepatic peliosis is often associated with chronic wasting diseases but also has been reported in association with anabolic, contraceptive, or other hormonal treatment, and even in context with HIV-related bacterial infections. Hepatic peliosis is usually clinically unapparent and mostly found only during autopsy, but occasionally it may lead to diagnostic problems if detected radiologically since the imaging findings in hepatic peliosis are quite variable according to the variety of its possible histologic features as well as the possibility of additional hemorrhage. We present a case of hepatic peliosis associated with bronchial carcinoma that showed moderate centripetal enhancement during the portal-venous phase on CT, pronounced venous pooling on contrast enhanced T1-weighted images acquired during the hepatic-venous phase, and bright signal on T2-weighted images, thus mimicking in some way a capillary hemangioma. We also discuss some not yet described CT and MR features of this rare entity which should be included into the differential diagnosis of atypical liver lesions in patients with the above-mentioned conditions.