Hemangiomas, the most common non-cystic hepatic lesions, are most often discovered by chance.
The radiologic imaging plays a critical role in the differential diagnosis of these lesions. On post contrast computed tomography and magnetic resonance images, most hemangiomas have a typical arterial peripheral nodular enhancement.
However, atypical hemangiomas, may imitate metastases or other hyper-vascular hepatic lesions.
The accurate diagnosis of these lesions is essential in order to determine the appropriate therapy. A variety of imaging modalities are currently available for evaluation of these cases. In our country triphasic CT/MRI studies have been widely used to reach the diagnosis.
Sclerosed haemangioma: Certain hemangiomas may degenerate with an extensive fibrosis beginning in the center of the lesion where the obliteration of the vascular spaces starts. This is also called a thrombosed or hyalinised hemangioma. The criteria indicating the diagnosis of sclerosed hemangioma are the geographic map appearance associated with a reduction in the volume of the hepatic parenchyma and capsular retraction.
Giant haemangioma: It consists of a cavernous hemangioma measuring over 4 cm in diameter. These hemangiomas may be the seat of thrombosis, liquefaction and fibrosis. A cystic cavity or central calcifications may appear. Internal septa are classically observed. The edges are regular without loss of parenchymal volume or capsular retraction.
Multiple hemangiomas: Consist of several hemangiomas distributed in thehepatic parenchyma.
Pedunculated hemangioma: The pedunculated hemangioma is a very rare lesion that develops extrahepatically.
It is well delimited, encapsulated, attached to the liver by a thin pedicle that is notalways visible in imaging.
Haemangioma and hepatic steatosis: Hepatic steatotic infiltration is known to modify the typical appearance of focal hepatic lesions.
Haemangioma and cirrhosis of the liver: The detection and lesional characterization of cirrhosis of the liver may pose a problem.
In fact, the progression of cirrhosis of the liver may induce a reduction in the size of hemangiomas.
They become more fibrous and more difficult to recognize radiologically and histologically. Capsular retraction may occur.
