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Imaging of Atypical Hemangiomas of the Liver with Pathologic Correlation¹

¹ From the Departments of Radiology (V.V., L.B., M.P.V., A.D., Y.M.) and Pathology (B.T.), Hôpital Beaujon, 100 boulevard du Général Leclerc, 92118 Clichy, France. Presented as a scientific exhibit at the 1998 RSNA scientific assembly. Received June 9, 1999; revision requested July 9 and received August 9; accepted August 12. Address reprint requests to V.V. (e-mail: valerie.vilgrain@bjn.ap-hop-paris.fr).

View larger version (155K): [in a new window]   Figure 1a.   Typical hemangioma. (a) Doppler US scan shows a homogeneous, hyperechoic lesion of the right hepatic lobe. No color signal is demonstrated. (b) Nonenhanced CT scan shows a hypoattenuating lesion of the right hepatic lobe. (c, d) Arterial-phase (c) and venous-phase (d) contrast material-enhanced CT scans show progressive, peripheral, globular enhancement, which is highly suggestive of hemangioma. (e) Delayed-phase CT scan shows that the lesion is isoattenuating relative to the liver, an appearance that suggests persistence of contrast material within the lesion.

View larger version (105K): [in a new window]   Figure 1b.   Typical hemangioma. (a) Doppler US scan shows a homogeneous, hyperechoic lesion of the right hepatic lobe. No color signal is demonstrated. (b) Nonenhanced CT scan shows a hypoattenuating lesion of the right hepatic lobe. (c, d) Arterial-phase (c) and venous-phase (d) contrast material-enhanced CT scans show progressive, peripheral, globular enhancement, which is highly suggestive of hemangioma. (e) Delayed-phase CT scan shows that the lesion is isoattenuating relative to the liver, an appearance that suggests persistence of contrast material within the lesion.

View larger version (131K): [in a new window]   Figure 1c.   Typical hemangioma. (a) Doppler US scan shows a homogeneous, hyperechoic lesion of the right hepatic lobe. No color signal is demonstrated. (b) Nonenhanced CT scan shows a hypoattenuating lesion of the right hepatic lobe. (c, d) Arterial-phase (c) and venous-phase (d) contrast material-enhanced CT scans show progressive, peripheral, globular enhancement, which is highly suggestive of hemangioma. (e) Delayed-phase CT scan shows that the lesion is isoattenuating relative to the liver, an appearance that suggests persistence of contrast material within the lesion.

View larger version (138K): [in a new window]   Figure 1d.   Typical hemangioma. (a) Doppler US scan shows a homogeneous, hyperechoic lesion of the right hepatic lobe. No color signal is demonstrated. (b) Nonenhanced CT scan shows a hypoattenuating lesion of the right hepatic lobe. (c, d) Arterial-phase (c) and venous-phase (d) contrast material-enhanced CT scans show progressive, peripheral, globular enhancement, which is highly suggestive of hemangioma. (e) Delayed-phase CT scan shows that the lesion is isoattenuating relative to the liver, an appearance that suggests persistence of contrast material within the lesion.

View larger version (135K): [in a new window]   Figure 1e.   Typical hemangioma. (a) Doppler US scan shows a homogeneous, hyperechoic lesion of the right hepatic lobe. No color signal is demonstrated. (b) Nonenhanced CT scan shows a hypoattenuating lesion of the right hepatic lobe. (c, d) Arterial-phase (c) and venous-phase (d) contrast material-enhanced CT scans show progressive, peripheral, globular enhancement, which is highly suggestive of hemangioma. (e) Delayed-phase CT scan shows that the lesion is isoattenuating relative to the liver, an appearance that suggests persistence of contrast material within the lesion.

View larger version (147K): [in a new window]   Figure 2.   Hemangioma with echoic border. US scan of the liver shows an echoic border surrounding an iso- or hypoechoic lesion.

View larger version (153K): [in a new window]   Figure 3a.   Large, heterogeneous hemangioma. (a) US scan of the liver shows a large, heterogeneous lesion with a hypoechoic center. (b) Nonenhanced CT scan shows a hypoattenuating lesion with a markedly hypoattenuating center. (c) Contrast-enhanced CT scan shows the typical enhancement pattern of hemangioma. (d) Delayed-phase CT scan shows incomplete filling of the lesion. (e) T1-weighted spin-echo MR image shows a markedly hypointense center and some hypointense linear elements within a hypointense lesion. (f) T2-weighted spin-echo MR image shows that the lesion is hyperintense relative to the liver with a markedly hyperintense center. Note the hypointense linear elements, which correspond to internal septa.

View larger version (132K): [in a new window]   Figure 3b.   Large, heterogeneous hemangioma. (a) US scan of the liver shows a large, heterogeneous lesion with a hypoechoic center. (b) Nonenhanced CT scan shows a hypoattenuating lesion with a markedly hypoattenuating center. (c) Contrast-enhanced CT scan shows the typical enhancement pattern of hemangioma. (d) Delayed-phase CT scan shows incomplete filling of the lesion. (e) T1-weighted spin-echo MR image shows a markedly hypointense center and some hypointense linear elements within a hypointense lesion. (f) T2-weighted spin-echo MR image shows that the lesion is hyperintense relative to the liver with a markedly hyperintense center. Note the hypointense linear elements, which correspond to internal septa.

View larger version (121K): [in a new window]   Figure 3c.   Large, heterogeneous hemangioma. (a) US scan of the liver shows a large, heterogeneous lesion with a hypoechoic center. (b) Nonenhanced CT scan shows a hypoattenuating lesion with a markedly hypoattenuating center. (c) Contrast-enhanced CT scan shows the typical enhancement pattern of hemangioma. (d) Delayed-phase CT scan shows incomplete filling of the lesion. (e) T1-weighted spin-echo MR image shows a markedly hypointense center and some hypointense linear elements within a hypointense lesion. (f) T2-weighted spin-echo MR image shows that the lesion is hyperintense relative to the liver with a markedly hyperintense center. Note the hypointense linear elements, which correspond to internal septa.

View larger version (136K): [in a new window]   Figure 3d.   Large, heterogeneous hemangioma. (a) US scan of the liver shows a large, heterogeneous lesion with a hypoechoic center. (b) Nonenhanced CT scan shows a hypoattenuating lesion with a markedly hypoattenuating center. (c) Contrast-enhanced CT scan shows the typical enhancement pattern of hemangioma. (d) Delayed-phase CT scan shows incomplete filling of the lesion. (e) T1-weighted spin-echo MR image shows a markedly hypointense center and some hypointense linear elements within a hypointense lesion. (f) T2-weighted spin-echo MR image shows that the lesion is hyperintense relative to the liver with a markedly hyperintense center. Note the hypointense linear elements, which correspond to internal septa.

View larger version (125K): [in a new window]   Figure 3e.   Large, heterogeneous hemangioma. (a) US scan of the liver shows a large, heterogeneous lesion with a hypoechoic center. (b) Nonenhanced CT scan shows a hypoattenuating lesion with a markedly hypoattenuating center. (c) Contrast-enhanced CT scan shows the typical enhancement pattern of hemangioma. (d) Delayed-phase CT scan shows incomplete filling of the lesion. (e) T1-weighted spin-echo MR image shows a markedly hypointense center and some hypointense linear elements within a hypointense lesion. (f) T2-weighted spin-echo MR image shows that the lesion is hyperintense relative to the liver with a markedly hyperintense center. Note the hypointense linear elements, which correspond to internal septa.

View larger version (108K): [in a new window]   Figure 3f.   Large, heterogeneous hemangioma. (a) US scan of the liver shows a large, heterogeneous lesion with a hypoechoic center. (b) Nonenhanced CT scan shows a hypoattenuating lesion with a markedly hypoattenuating center. (c) Contrast-enhanced CT scan shows the typical enhancement pattern of hemangioma. (d) Delayed-phase CT scan shows incomplete filling of the lesion. (e) T1-weighted spin-echo MR image shows a markedly hypointense center and some hypointense linear elements within a hypointense lesion. (f) T2-weighted spin-echo MR image shows that the lesion is hyperintense relative to the liver with a markedly hyperintense center. Note the hypointense linear elements, which correspond to internal septa.

View larger version (107K): [in a new window]   Figure 4a.   Rapidly filling hemangioma. (a) Early-phase T1-weighted MR image shows immediate homogeneous enhancement of a small lesion (arrow). (b) Delayed-phase T1-weighted MR image shows persistent enhancement of the lesion. The diagnosis was proved with biopsy.

View larger version (128K): [in a new window]   Figure 4b.   Rapidly filling hemangioma. (a) Early-phase T1-weighted MR image shows immediate homogeneous enhancement of a small lesion (arrow). (b) Delayed-phase T1-weighted MR image shows persistent enhancement of the lesion. The diagnosis was proved with biopsy.

View larger version (119K): [in a new window]   Figure 5a.   Calcified hemangioma. (a) US scan of the liver shows an isoechoic lesion with a large calcification. (b, c) Arterial-phase (b) and venous-phase (c) contrast-enhanced CT scans show a large calcification within a hypoattenuating lesion. (d) T2-weighted MR image shows that the lesion is isointense relative to cerebrospinal fluid; the large central area of low signal intensity corresponds to the calcification. The diagnosis was proved with pathologic examination after surgical resection.

View larger version (96K): [in a new window]   Figure 5b.   Calcified hemangioma. (a) US scan of the liver shows an isoechoic lesion with a large calcification. (b, c) Arterial-phase (b) and venous-phase (c) contrast-enhanced CT scans show a large calcification within a hypoattenuating lesion. (d) T2-weighted MR image shows that the lesion is isointense relative to cerebrospinal fluid; the large central area of low signal intensity corresponds to the calcification. The diagnosis was proved with pathologic examination after surgical resection.

View larger version (102K): [in a new window]   Figure 5c.   Calcified hemangioma. (a) US scan of the liver shows an isoechoic lesion with a large calcification. (b, c) Arterial-phase (b) and venous-phase (c) contrast-enhanced CT scans show a large calcification within a hypoattenuating lesion. (d) T2-weighted MR image shows that the lesion is isointense relative to cerebrospinal fluid; the large central area of low signal intensity corresponds to the calcification. The diagnosis was proved with pathologic examination after surgical resection.

View larger version (91K): [in a new window]   Figure 5d.   Calcified hemangioma. (a) US scan of the liver shows an isoechoic lesion with a large calcification. (b, c) Arterial-phase (b) and venous-phase (c) contrast-enhanced CT scans show a large calcification within a hypoattenuating lesion. (d) T2-weighted MR image shows that the lesion is isointense relative to cerebrospinal fluid; the large central area of low signal intensity corresponds to the calcification. The diagnosis was proved with pathologic examination after surgical resection.

View larger version (153K): [in a new window]   Figure 6.   Calcified hemangioma. Nonenhanced CT scan shows an ill-defined lesion of the right hepatic lobe with multiple spotty calcifications. The diagnosis was proved with surgical biopsy.

View larger version (129K): [in a new window]   Figure 7a.   Hyalinized hemangioma. (a) Contrast-enhanced CT scan shows a large, hypoattenuating lesion in segment VII. (b) Delayed-phase CT scan shows heterogeneous uptake of contrast material by the lesion. (c) T2-weighted spin-echo MR image shows that the lesion is heterogeneous and less hyperintense than cerebrospinal fluid. (d) Photograph of the pathologic specimen shows extensive fibrosis within the lesion.

View larger version (132K): [in a new window]   Figure 7b.   Hyalinized hemangioma. (a) Contrast-enhanced CT scan shows a large, hypoattenuating lesion in segment VII. (b) Delayed-phase CT scan shows heterogeneous uptake of contrast material by the lesion. (c) T2-weighted spin-echo MR image shows that the lesion is heterogeneous and less hyperintense than cerebrospinal fluid. (d) Photograph of the pathologic specimen shows extensive fibrosis within the lesion.

View larger version (144K): [in a new window]   Figure 7c.   Hyalinized hemangioma. (a) Contrast-enhanced CT scan shows a large, hypoattenuating lesion in segment VII. (b) Delayed-phase CT scan shows heterogeneous uptake of contrast material by the lesion. (c) T2-weighted spin-echo MR image shows that the lesion is heterogeneous and less hyperintense than cerebrospinal fluid. (d) Photograph of the pathologic specimen shows extensive fibrosis within the lesion.

View larger version (115K): [in a new window]   Figure 7d.   Hyalinized hemangioma. (a) Contrast-enhanced CT scan shows a large, hypoattenuating lesion in segment VII. (b) Delayed-phase CT scan shows heterogeneous uptake of contrast material by the lesion. (c) T2-weighted spin-echo MR image shows that the lesion is heterogeneous and less hyperintense than cerebrospinal fluid. (d) Photograph of the pathologic specimen shows extensive fibrosis within the lesion.

View larger version (135K): [in a new window]   Figure 8.   Hemangioma with fluid-fluid level. T2-weighted spin-echo MR image shows a lesion with a fluid-fluid level (arrowheads). The inferior fluid layer is hypointense relative to the superior fluid layer. (Courtesy of Philippe Soyer, MD, PhD, Hôpital Lariboisière, Paris, France.)

View larger version (140K): [in a new window]   Figure 9.   Pedunculated hemangioma. Contrast-enhanced CT scan shows a pedunculated hemangioma (arrowheads). The connection of the hemangioma to the liver was seen on a more cranial section. The diagnosis was suggested by the typical enhancement pattern and the typical MR imaging features.

View larger version (159K): [in a new window]   Figure 10a.   Hemangioma with arterial-portal venous shunt. (a) Arterial-phase CT scan shows early peripheral enhancement of a hypoattenuating lesion of segment IV. Note the filling of the right portal vein (arrows). (b) Arterial-phase T1-weighted gradient-echo MR image shows early filling of the right portal vein (arrows). (c) Selective hepatic angiogram shows irregular enhancement of the lesion associated with early opacification of the right portal vein (arrows). (d) Photograph of the resected specimen shows the hemangioma.

View larger version (146K): [in a new window]   Figure 10b.   Hemangioma with arterial-portal venous shunt. (a) Arterial-phase CT scan shows early peripheral enhancement of a hypoattenuating lesion of segment IV. Note the filling of the right portal vein (arrows). (b) Arterial-phase T1-weighted gradient-echo MR image shows early filling of the right portal vein (arrows). (c) Selective hepatic angiogram shows irregular enhancement of the lesion associated with early opacification of the right portal vein (arrows). (d) Photograph of the resected specimen shows the hemangioma.

View larger version (131K): [in a new window]   Figure 10c.   Hemangioma with arterial-portal venous shunt. (a) Arterial-phase CT scan shows early peripheral enhancement of a hypoattenuating lesion of segment IV. Note the filling of the right portal vein (arrows). (b) Arterial-phase T1-weighted gradient-echo MR image shows early filling of the right portal vein (arrows). (c) Selective hepatic angiogram shows irregular enhancement of the lesion associated with early opacification of the right portal vein (arrows). (d) Photograph of the resected specimen shows the hemangioma.

View larger version (109K): [in a new window]   Figure 10d.   Hemangioma with arterial-portal venous shunt. (a) Arterial-phase CT scan shows early peripheral enhancement of a hypoattenuating lesion of segment IV. Note the filling of the right portal vein (arrows). (b) Arterial-phase T1-weighted gradient-echo MR image shows early filling of the right portal vein (arrows). (c) Selective hepatic angiogram shows irregular enhancement of the lesion associated with early opacification of the right portal vein (arrows). (d) Photograph of the resected specimen shows the hemangioma.

View larger version (113K): [in a new window]   Figure 11.   Hemangioma with capsular retraction. T2-weighted MR image shows a markedly hyperintense lesion in segments IV and VIII with capsular retraction (arrow). The diagnosis was proved with surgical biopsy and follow-up for 8 years.

View larger version (170K): [in a new window]   Figure 12a.   Nodular hyperplasia surrounding hemangioma. (a, b) Contrast-enhanced CT scan (a) and contrast-enhanced T1-weighted gradient-echo MR image (b) show a lesion with continuous peripheral enhancement (arrowheads). Note the enhancement of the adjacent parenchyma (arrows). (c) T2-weighted spin-echo MR image shows a homogeneous, hyperintense lesion. Pathologic examination after surgical resection revealed a hemangioma surrounded by regenerative nodular hyperplasia.

View larger version (164K): [in a new window]   Figure 12b.   Nodular hyperplasia surrounding hemangioma. (a, b) Contrast-enhanced CT scan (a) and contrast-enhanced T1-weighted gradient-echo MR image (b) show a lesion with continuous peripheral enhancement (arrowheads). Note the enhancement of the adjacent parenchyma (arrows). (c) T2-weighted spin-echo MR image shows a homogeneous, hyperintense lesion. Pathologic examination after surgical resection revealed a hemangioma surrounded by regenerative nodular hyperplasia.

View larger version (160K): [in a new window]   Figure 12c.   Nodular hyperplasia surrounding hemangioma. (a, b) Contrast-enhanced CT scan (a) and contrast-enhanced T1-weighted gradient-echo MR image (b) show a lesion with continuous peripheral enhancement (arrowheads). Note the enhancement of the adjacent parenchyma (arrows). (c) T2-weighted spin-echo MR image shows a homogeneous, hyperintense lesion. Pathologic examination after surgical resection revealed a hemangioma surrounded by regenerative nodular hyperplasia.

View larger version (132K): [in a new window]   Figure 13a.   Hemangioma in a fatty liver. (a) Nonenhanced CT scan shows multiple hyperattenuating lesions in a hypoattenuating fatty liver parenchyma. (b) Arterial-phase CT scan shows that the lesions are mostly isoattenuating relative to the liver. (c) Portal-phase CT scan shows enhancement of the lesions. (d) T2-weighted MR image shows typical hemangiomas. The diagnosis was suggested by the typical enhancement pattern and the typical MR imaging features.

View larger version (125K): [in a new window]   Figure 13b.   Hemangioma in a fatty liver. (a) Nonenhanced CT scan shows multiple hyperattenuating lesions in a hypoattenuating fatty liver parenchyma. (b) Arterial-phase CT scan shows that the lesions are mostly isoattenuating relative to the liver. (c) Portal-phase CT scan shows enhancement of the lesions. (d) T2-weighted MR image shows typical hemangiomas. The diagnosis was suggested by the typical enhancement pattern and the typical MR imaging features.

View larger version (118K): [in a new window]   Figure 13c.   Hemangioma in a fatty liver. (a) Nonenhanced CT scan shows multiple hyperattenuating lesions in a hypoattenuating fatty liver parenchyma. (b) Arterial-phase CT scan shows that the lesions are mostly isoattenuating relative to the liver. (c) Portal-phase CT scan shows enhancement of the lesions. (d) T2-weighted MR image shows typical hemangiomas. The diagnosis was suggested by the typical enhancement pattern and the typical MR imaging features.

View larger version (119K): [in a new window]   Figure 13d.   Hemangioma in a fatty liver. (a) Nonenhanced CT scan shows multiple hyperattenuating lesions in a hypoattenuating fatty liver parenchyma. (b) Arterial-phase CT scan shows that the lesions are mostly isoattenuating relative to the liver. (c) Portal-phase CT scan shows enhancement of the lesions. (d) T2-weighted MR image shows typical hemangiomas. The diagnosis was suggested by the typical enhancement pattern and the typical MR imaging features.

View larger version (121K): [in a new window]   Figure 14.   Multiple hemangiomas. T2-weighted spin-echo MR image shows multiple hyperintense lesions, an appearance consistent with hemangiomas.

View larger version (123K): [in a new window]   Figure 15a.   Hemangiomatosis. (a) US scan of the liver shows large, ill-defined, hypoechoic areas. (b) Nonenhanced CT scan shows large, hypoattenuating areas. (c) Early-phase CT scan shows enhancement of only the normal parenchyma (arrows). (d) Delayed-phase CT scan shows that the liver is homogeneous because the hemangiomas have enhanced. (e) T2-weighted spin-echo MR image shows marked ill-defined high signal intensity, which corresponds to hemangiomatosis. The diagnosis was proved with surgical biopsy.

View larger version (125K): [in a new window]   Figure 15b.   Hemangiomatosis. (a) US scan of the liver shows large, ill-defined, hypoechoic areas. (b) Nonenhanced CT scan shows large, hypoattenuating areas. (c) Early-phase CT scan shows enhancement of only the normal parenchyma (arrows). (d) Delayed-phase CT scan shows that the liver is homogeneous because the hemangiomas have enhanced. (e) T2-weighted spin-echo MR image shows marked ill-defined high signal intensity, which corresponds to hemangiomatosis. The diagnosis was proved with surgical biopsy.

View larger version (133K): [in a new window]   Figure 15c.   Hemangiomatosis. (a) US scan of the liver shows large, ill-defined, hypoechoic areas. (b) Nonenhanced CT scan shows large, hypoattenuating areas. (c) Early-phase CT scan shows enhancement of only the normal parenchyma (arrows). (d) Delayed-phase CT scan shows that the liver is homogeneous because the hemangiomas have enhanced. (e) T2-weighted spin-echo MR image shows marked ill-defined high signal intensity, which corresponds to hemangiomatosis. The diagnosis was proved with surgical biopsy.

View larger version (111K): [in a new window]   Figure 15d.   Hemangiomatosis. (a) US scan of the liver shows large, ill-defined, hypoechoic areas. (b) Nonenhanced CT scan shows large, hypoattenuating areas. (c) Early-phase CT scan shows enhancement of only the normal parenchyma (arrows). (d) Delayed-phase CT scan shows that the liver is homogeneous because the hemangiomas have enhanced. (e) T2-weighted spin-echo MR image shows marked ill-defined high signal intensity, which corresponds to hemangiomatosis. The diagnosis was proved with surgical biopsy.

View larger version (114K): [in a new window]   Figure 15e.   Hemangiomatosis. (a) US scan of the liver shows large, ill-defined, hypoechoic areas. (b) Nonenhanced CT scan shows large, hypoattenuating areas. (c) Early-phase CT scan shows enhancement of only the normal parenchyma (arrows). (d) Delayed-phase CT scan shows that the liver is homogeneous because the hemangiomas have enhanced. (e) T2-weighted spin-echo MR image shows marked ill-defined high signal intensity, which corresponds to hemangiomatosis. The diagnosis was proved with surgical biopsy.

View larger version (149K): [in a new window]   Figure 16.   Hemangioma associated with focal nodular hyperplasia. T2-weighted spin-echo MR image shows a hemangioma of the left hepatic lobe (arrowheads). The superior part of a lesion of focal nodular hyperplasia is seen within segment VII (arrows); the central scar was seen more caudally.

View larger version (119K): [in a new window]   Figure 17a.   Hemangioma enlarging over time. (a) US scan of the liver from 1987 shows a 3-cm-diameter hyperechoic lesion of the right lobe. (b) US scan of the liver from 1996 shows that the lesion has grown (diameter, 6.5 cm). The diagnosis was proved with percutaneous biopsy.

View larger version (107K): [in a new window]   Figure 17b.   Hemangioma enlarging over time. (a) US scan of the liver from 1987 shows a 3-cm-diameter hyperechoic lesion of the right lobe. (b) US scan of the liver from 1996 shows that the lesion has grown (diameter, 6.5 cm). The diagnosis was proved with percutaneous biopsy.

View larger version (116K): [in a new window]   Figure 18a.   Hemangioma with intratumoral hemorrhage. (a) Nonenhanced CT scan shows a large, heterogeneous lesion of segment IV (arrows) with a subcapsular hematoma (arrowheads). Note the presence of another hypoattenuating lesion. (b) T1-weighted MR image shows hypointense lesions with hyperintense foci, findings consistent with hemorrhage. (c) T2-weighted MR image shows markedly hyperintense lesions. (d) Photograph of the resected specimen shows a complicated hemorrhagic hemangioma. Scale is in millimeters.

View larger version (139K): [in a new window]   Figure 18b.   Hemangioma with intratumoral hemorrhage. (a) Nonenhanced CT scan shows a large, heterogeneous lesion of segment IV (arrows) with a subcapsular hematoma (arrowheads). Note the presence of another hypoattenuating lesion. (b) T1-weighted MR image shows hypointense lesions with hyperintense foci, findings consistent with hemorrhage. (c) T2-weighted MR image shows markedly hyperintense lesions. (d) Photograph of the resected specimen shows a complicated hemorrhagic hemangioma. Scale is in millimeters.

View larger version (143K): [in a new window]   Figure 18c.   Hemangioma with intratumoral hemorrhage. (a) Nonenhanced CT scan shows a large, heterogeneous lesion of segment IV (arrows) with a subcapsular hematoma (arrowheads). Note the presence of another hypoattenuating lesion. (b) T1-weighted MR image shows hypointense lesions with hyperintense foci, findings consistent with hemorrhage. (c) T2-weighted MR image shows markedly hyperintense lesions. (d) Photograph of the resected specimen shows a complicated hemorrhagic hemangioma. Scale is in millimeters.

View larger version (122K): [in a new window]   Figure 18d.   Hemangioma with intratumoral hemorrhage. (a) Nonenhanced CT scan shows a large, heterogeneous lesion of segment IV (arrows) with a subcapsular hematoma (arrowheads). Note the presence of another hypoattenuating lesion. (b) T1-weighted MR image shows hypointense lesions with hyperintense foci, findings consistent with hemorrhage. (c) T2-weighted MR image shows markedly hyperintense lesions. (d) Photograph of the resected specimen shows a complicated hemorrhagic hemangioma. Scale is in millimeters.

View larger version (125K): [in a new window]   Figure 19.   Compressive hemangioma. Contrast-enhanced CT scan shows a large hemangioma, which compresses the right branch of the portal vein.