Male 38 years old; Reason: patient w/ liver failure, large hemangioma, eval for other masses History: liver failure ABDOMEN:LUNGS BASES: Small pleural effusions.LIVER, BILIARY TRACT: Hepatomegaly, liver measures 24 cm in longitudinal dimension. Large somewhat geographic area of signal abnormality involving left hepatic lobe and extending into hepatic segments 8 and 5 of right hepatic lobe (measures up to 25 cm in transverse dimension on image 40 series 1201). Areas of arterially enhancing nodular enhancement are visualized throughout this region of interest. There appears to be progressive centripetal filling in of the area on portal venous and delayed phases of postcontrast imaging. Only mild corresponding T2 hyperintensity appreciated, may reflect extensive hyalinization. Additionally there is mildly heterogeneous enhancement of the remaining right hepatic lobe, presumably related to perfusional changes secondary to aforementioned large area of signal abnormality. No definite evidence of underlying cirrhosis. Visualized portal and hepatic veins and hepatic arteries patent. Narrowed intrahepatic IVC. Gallbladder wall thickened and edematous, nonspecific in setting of ascites, no additional signs of acute cholecystitis, no significant gallbladder distention. Submitted MRCP images are nondiagnostic. However no evidence of biliary ductal dilatation on either fluid-sensitive axial and coronal images. Perihepatic/periportal lymphadenopathy, reference lymph node submitted that measures approximately 2.9 x 1.6 cm on image 127 series 13.SPLEEN: Measures 12.9 cm in longitudinal dimension.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Perihepatic/periportal lymphadenopathy as above.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Anasarca present.OTHER: Small to moderate ascites.
1. Hepatomegaly with large area of signal abnormality involving left hepatic lobe and portions of anterior right hepatic lobe that demonstrates extensive nodular arterial enhancement with progressive centripetal filling in of area on more delayed imaging. While these findings would be typical for a giant cavernous hemangioma, the absence of characteristic corresponding T2 hyperintense signal is very atypical; the appearance could reflect extensive hyalinization within the hemangioma but is still very unusual. An underlying malignancy such as lymphoma cannot be excluded on the basis of this imaging study. Perihepatic/periportal lymphadenopathy also seen. Correlation with patient's reported liver biopsy at OSH recommended and if needed re-biopsy with special processing to exclude lymphoma should be considered. Follow up with a nuclear medicine liver hemangioma RBC scan may be useful. Hemangiomatosis considered unlikely given its rare occurrence in an adult patient and again the absence of associated hyperintense T2 signal; diffuse hepatic hemangiomatosis also typically characterized by involvement of a minimum of two visceral organs and hemangiomas affecting the skin. 2. Gallbladder wall thickened and edematous, nonspecific in setting of ascites, no additional signs of acute cholecystitis, no significant gallbladder distention. 3. Submitted MRCP images are nondiagnostic. However no evidence of biliary ductal dilatation on either fluid-sensitive axial and coronal images. 4. Small to moderate ascites. 5. Small pleural effusions.