Hepatic hemangioma presenting atypical radiologic findings: a case report

A 69-year-old woman was referred to our hospital due to a liver tumor that was incidentally noted on ultrasound (US). US revealed a pedunculated mass of 5 cm in diameter, with a heterogeneous echo pattern. On arterial phase dynamic contrast-enhanced computed tomography (CT), a tiny enhancing dot in the upper aspect of the mass was seen; whereas, the main portion of the lesion appeared as hypoattenuating. The tumor was of low intensity on T1-weighted magnetic resonance (MR) images, and showed slightly heterogeneous high intensity on T2-weighted MR images. The most characteristic feature of the tumor was its exophytic appearance. On post-gadolinium hepatic arterial dominant-phase MR images, the tumor showed nodular enhancement centrally, with progressive spread of enhancement on later images. Angiography showed dilatation of the right posterior inferior branch of the hepatic artery and C-shaped opacification. Since we could not rule out malignancy for these nonspecific radiologic findings, a partial resection of the liver was carried out, resulting in a pathological diagnosis of hepatic hemangioma. This hemangioma had marked hyalinization and fibrosis, causing a heterogeneous appearance on MR images. The tumor presented an exophytic appearance, which caused some diagnostic confusion.