Shimizu et al evaluated hepatic hemangiomas that were resected in patients with cancer and suspected hepatic metastases. The authors are from the National Cancer Center Hospital in Tokyo, Japan.


Typical scenario: Adult (usually male) with a diagnosis of cancer and a hepatic lesion detected on an imaging study.


Problems with needle biopsies of a hepatic mass:

(1) false positive diagnosis

(2) hemorrhage, which can be significant and even fatal


Features of hepatic hamangiomas:

(1) diameter often less than 4 cm

(2) presence of discrepancies in the radiologic diagnosis

(3) absence of a rapid increase in size


A patient with these 3 features could be followed, especially if the CT images with and without contrast are compatible with a hepatic hemangioma. The typical hemangioma is hypodense in a CT scan without contrast. After contrast administration there is peripheral enhancement that progresses in a centripetal fashion.


Problems arise when:

(1) there are multiple hemangiomas

(2) thrombosis occurs, with hemorrhage and necrosis

(3) small lesions with an atypical imaging study


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