An exceedingly rare case of de novo hepatic angiosarcoma in a transplanted liver

De novo primary hepatic angiosarcoma is an exceedingly rare malignancy in transplanted livers. Only 1 previous case has been reported in the literature. The diagnosis is usually challenging due to non-specific clinical presentation and overlapping imaging findings with other conditions. These rapidly progressing, multifocal lesions have previously been described to have varied growth patterns but are typically hypo-enhancing on gadoxetate disodium (Primovist) enhanced MRI. Surgical resection and adjuvant chemotherapy are potential options of treatment for hepatic angiosarcomas. Despite this, prognosis of patients at diagnosis is extremely poor. In this report we present imaging findings of a liver transplant recipient despite biopsy-confirmed hepatic angiosarcoma, and discuss the diagnostic complexities involved.