Multimodality Imaging Evaluation of Hepatic Epithelioid Angiomyolipoma

Hepatic epithelioid angiomyolipoma (HEAML) is a rare benign tumor in the liver. It is crucial to differentiate HEAML from hepatocellular carcinoma. We herein report the case of a 42-year-old female who was diagnosed with HEAML by multiple imaging studies. The histopathological examination also confirmed the diagnosis. Imaging studies include magnetic resonance imaging, digital subtraction angiography (DSA), and contrast-enhanced ultrasound (US). Typical image findings of HEAML by US include early drainage of hepatic veins, higher peak intensity, shorter time to peak on time-intensity curve, and a larger wash-in area under the curve after ultrasonic contrast injection. Early hepatic drainage vein(s) detected at CEUS are a crucial diagnosis of HEAML. DSA can also provide valuable vascular details. This case highlights the importance of recognizing the imaging features of HEAML to avoid misdiagnosis and unnecessary surgical interventions. We present various imaging techniques and their findings and emphasize the application of CEUS in the diagnosis of HEAML.