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Accidental finding of spontaneous hemorrhage within giant hepatic hemangioma

We evaluated clinical course and role of magnetic resolution imaging (MRI) in follow up of patient with accidental finding of spontaneous hemorrhage within giant hepatic hemangioma.We present a case of 55-years-old female patient who was admitted to our hospital after a large liver mass was recorded on ultrasound examination during a routine gynecology check-up. Patient was asymptomatic, but had laboratory signs of bleeding. Initial imaging methods used were multi-sliced computed tomography (MSCT) and MRI and because the patient was stabile, we decided for conservative treatment and follow-up with MRI. Abdominal MSCT showed 19 x 17 cm large, hypodense mass that occupied 4th, 5th and 8th segment of the liver with central areas of high attenuation suggestive for bleeding. Contrast-enhanced dynamic serial MSCT showed peripheral nodular enhancement during arterial phase progressing centripetally in portal-venous phase typical for cavernous hemangioma, with incomplete filling-in during equilibrium phase. MRI performed one week later showed on T2 weighted images large, mainly hyperintense mass with several ring-like, 2 to 3 mm thick, low-intensity bands. T1 weighted images revealed inside this mass at least 5 lesions with central low signal intensity and peripheral rim of high signal intensity which is diagnostic for subacute hematomas. Control MRI performed 6 months later showed on T2-weighted images size regression and formation of hypointense rim with central hyperintense signal intensity inside the hematomas. On T1-weighted images hematomas were hyperintense. Six months later on control MRI no substantial changes were found. Hemorrhage within giant hepatic cavernous hemangioma can be asymptomatic and spontaneous regression is possible. Substantial changes from subacute to chronic stage can be evaluated with MRI.

hepatic hemangioma; bleeding; imaging methods; MRI

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