DOI: 10.1148/rg.246035188
Pediatric Hepatic Hemangioma1
Todd S. Regier, MD and
Faridali G. Ramji, MD
1 From the Department of Radiology, Children’s Hospital, University of Oklahoma Health Sciences Center, Rm 1100B, 940 NE 13th St, Oklahoma City, OK 73104. Received September 2, 2003; revision requested October 28 and received December 12; accepted December 22. Both authors have no financial relationships to disclose. Address correspondence to T.S.R. (e-mail: todd-regier@ouhsc.edu).
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Figure 1. Photograph obtained during laparoscopy demonstrates a large abdominal mass that appears to arise from the inferior right hepatic lobe. Extensive superficial vascularity is also seen (arrow).
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Figure 2a. (a) Longitudinal US image demonstrates a large, moderately echogenic solid mass (M) in the right upper quadrant. The mass appears to be contiguous with the right lobe of the liver (L) and causes mass effect (black arrowhead) on the kidney (K). Scattered small, nonshadowing hyperechoic foci (white arrowhead) are also seen but did not prove to represent calcifications. (b) Doppler US image demonstrates increased peripheral flow within the mass (arrowhead), with the central portion demonstrating much less vascularity.
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Figure 2b. (a) Longitudinal US image demonstrates a large, moderately echogenic solid mass (M) in the right upper quadrant. The mass appears to be contiguous with the right lobe of the liver (L) and causes mass effect (black arrowhead) on the kidney (K). Scattered small, nonshadowing hyperechoic foci (white arrowhead) are also seen but did not prove to represent calcifications. (b) Doppler US image demonstrates increased peripheral flow within the mass (arrowhead), with the central portion demonstrating much less vascularity.
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Figure 3. Anteroposterior radiograph of the abdomen shows a soft-tissue mass in the right side of the midabdomen causing mass effect on the adjacent gas-filled colon (arrowhead), which is displaced laterally. There were no obvious calcifications within the mass, whose opacity is similar to that of the liver.
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Figure 4. Unenhanced CT scan demonstrates a prominent inferior right hepatic lobe and an indistinct mass (M) with subtly decreased attenuation relative to the normal parenchyma anteriorly. This subtle difference was more clearly visualized with liver windowing. No calcifications are seen.
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Figure 5a. (a) Dynamic CT scan obtained immediately after contrast material injection demonstrates a large mass with peripheral enhancement in the inferior right hepatic lobe. The central two-thirds of the mass is relatively hypoattenuating. The mass causes mass effect on the adjacent right kidney. A thin rim of normal liver is seen anteriorly and demonstrates less enhancement than the mass. (b) Delayed CT scan obtained 8 minutes after contrast material injection shows the mass with some washout of the peripheral enhancement and an attenuation that is closer to that of normal liver. The mass demonstrates persistent hypoattenuation centrally.
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Figure 5b. (a) Dynamic CT scan obtained immediately after contrast material injection demonstrates a large mass with peripheral enhancement in the inferior right hepatic lobe. The central two-thirds of the mass is relatively hypoattenuating. The mass causes mass effect on the adjacent right kidney. A thin rim of normal liver is seen anteriorly and demonstrates less enhancement than the mass. (b) Delayed CT scan obtained 8 minutes after contrast material injection shows the mass with some washout of the peripheral enhancement and an attenuation that is closer to that of normal liver. The mass demonstrates persistent hypoattenuation centrally.
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Figure 6. Photograph shows the sectioned gross specimen of the hepatic hemangioma with minimal normal liver tissue. The whitish central portion corresponds to the region of poor enhancement seen at initial contrast material-enhanced CT (cf Fig 5a).
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Figure 7a. (a) Low-power photomicrograph (original magnification, x10; hematoxylin-eosin stain) demonstrates vascular channels of varying size in the hemangioma. The vascular channels are lined with endothelium but contain no blood cells (B indicates one such channel). Note the surrounding fibroproliferative tissue with scarce liver parenchyma. (b) Low-power photomicrograph (original magnification, x40; hematoxylin-eosin stain) demonstrates a thrombosed vascular channel (B) within the hemangioma.
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Figure 7b. (a) Low-power photomicrograph (original magnification, x10; hematoxylin-eosin stain) demonstrates vascular channels of varying size in the hemangioma. The vascular channels are lined with endothelium but contain no blood cells (B indicates one such channel). Note the surrounding fibroproliferative tissue with scarce liver parenchyma. (b) Low-power photomicrograph (original magnification, x40; hematoxylin-eosin stain) demonstrates a thrombosed vascular channel (B) within the hemangioma.
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Copyright © 2004 by the Radiological Society of North America.
