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MedPix Medical Image Database
COW - Case of the WeekCase Contributor: Brittany RitchieAffiliation: National Capital Consortium
MedPix No: 12635 - HistoryPt Demographics: Age = 38 y.o. Gender = woman38 y/o woman to evaluate liver lesion.
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Hemangioma of Liver
Non-contrast axial CT image of the liver demonstrating a large hypoattenuating lesion in the peripheral subcapsular right lobe of the liver.
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Liver Hemangioma
During the arterial phase of contrast enhancement there is peripheral puddling of contrast (nodular enhancement).
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Hepatic Hemangioma
Dynamic enhanced images in portal venous phase demonstrating shows progressive discontinuous peripheral puddling of contrast enhancement.
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Hemangioma
Contrast enhanced axial CT image of the liver in portal venous phase demonstrating a large hypodense lesion in the right lobe of the liver with progressive discontinuous peripheral puddling of contrast enhancement.
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Hemangioma
Contrast enhanced axial CT image of the liver in portal venous phase demonstrating a large hypodense lesion in the right lobe of the liver with progressive discontinuous peripheral puddling of contrast enhancement.
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Hemangioma of the liver
Delayed images from the dynamic contrast enhanced axial CT shows *fill=in* of the lesion.
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FINDINGSDiscontinuous peripheral pooling of contrast enhancement in the arterial phase with progressive filling seen in the portal venous phase and prolonged enhancement of the lesion in delayed images on a three phase enhanced liver CT.
DIFFERENTIAL DIAGNOSISWhat is your Differential Diagnosis?DDX of hypodense liver lesion:- Cavernous hemangioma- Metastatic disease - HCC- Focal Nodular Hyperplasia- Hepatic cyst- Fibrolamellar Carcinoma- Lymphoma- Hepatic Adenoma-
Diagnosis: Liver HemangiomaDx Confirmed by: Imaging is diagnostic. No further confirmation required.
DISCUSSIONNOTE: These are dynamic enhanced images that confirm benign hemangioma. The discontinuous peripheral pooling of contrast enhancement in the arterial phase - followed by progressive filling seen in the portal venous phase - with prolonged enhancement of the lesion on the delayed images - is classic for hemangioma.