Multiple hepatic hemangiomas with significant arterioportal venous shunting

A patient with multiple hepatic hemangiomas and significant arterioportal shunting who was successfully treated by a left-hepatic lobectomy is presented herein. In hemangiomas with significant arterioportal venous shunting, it is essential to differentiate between hepatocellular carcinoma and hypervascular metastatic tumors because few typical findings of hemangioma can be recognized. Moreover, an increased hepatic arterial flow can increase the risk of spontaneous rupture as well as portal hypertension due to the increased inflow to the portal vein. Therefore, a definitive diagnosis should be made by liver biopsy when imaging alone is not sufficient to rule out malignancy. Furthermore, hepatic resection for hemangiomas with significant arterioportal venous shunting may be indicated due to the higher risk of rupture and the possibility of progressive portal hypertension.