Primary hepatic angiosarcoma mistaken for a giant hemangioma

Primary hepatic angiosarcoma (PHA) is a rare hepatic mesenchymal tumor that accounts for 2% of all primary malignant liver tumors. It typically presents with nonspecific symptoms, is highly aggressive, and there are limited treatment options. Imaging characteristics of PHA overlap with that of hepatic hemangioma, a common benign hepatic lesion, creating a potential diagnostic pitfall. We present a case of PHA that mimicked hepatic hemangioma on imaging. We review the differentiating characteristics between these two hepatic tumors. PHAs demonstrate irregular/infiltrating margins, higher lesion multiplicity, higher risk of tumor rupture, and rapid growth, which are not typically seen with hepatic hemangiomas.