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
