Sonography of hepatic hemangioma accompanied by arterioportal shunt
A 58-year-old man visited our hospital with right upper quadrant pain. His clinical history did not include any specific disease, family history was unremarkable, and physical examination was unremarkable. The results of routine laboratory investigations were unremarkable as well. Serologic tests for hepatitis A, B, and C were negative.\nHepatic sonography showed increased liver echogenicity, suggestive of hepatic steatosis. Gallbladder was unremarkable, and there was no remarkable abnormal finding in the biliary tree and pancreas as well. In the subcapsular area of the right hepatic lobe, there was a 2-cm, well-defined nodule with echo-poor appearance, surrounded by large geographic perinodular hypoechoic area, suggestive of peritumoral sparing of hepatic steatosis (). There was no thrombus at the portal branch, in the spared area of hepatic steatosis around the tumor. Doppler study revealed hypervascularity of the tumor and the reverse hepatofugal flow of the peritumoral portal vein parallel to the feeding artery, indicating the presence of arterioportal shunt accompanying the tumor. Based on grayscale and Doppler sonographic findings, hepatic hemangioma with arterioportal shunt was highly suspected.\nUnenhanced and postcontrast dynamic CT scans were performed for further evaluation of hepatic tumor. Unenhanced CT scan showed decrease of hepatic parenchymal attenuation, suggestive of hepatic steatosis. The tumor was seen as low attenuation nodule in the subcapsular area of the right hepatic lobe, surrounded by subtle hyperdense area, suggesting peritumoral sparing of steatosis. Dynamic contrast-enhanced CT showed strong homogenous enhancement of the tumor, surrounded by large wedge-shaped parenchymal hyperenhancement during the arterial phase. The tumor showed persistent enhancement similar to hepatic vessels and the surrounding parenchymal hyperenhancement was also appreciated during the venous phase. Several small nodules (< 1 cm) with similar enhancement pattern as the one described above were also noted in both hepatic lobes. The diagnosis of hepatic hemangiomas with arterioportal shunt was made by typical CT features.