CT of giant cavernous hemangioma

Giant hepatic cavernous hemangiomas are clinically distinct from smaller asymptomatic ones and may be confused with primary or metastatic malignancy. Hemangiomas exceeding 8 cm in diameter (mean, 13.7 cm) were studied in eight women 28-71 years old, six of whom presented with right upper quadrant discomfort and/or hepatomegaly. On unenhanced CT, seven of the masses were less dense than surrounding normal liver and one was slightly more dense than adjacent fatty liver. All masses contained additional stellate or cleftlike low-density zones, and two contained calcification. After bolus IV contrast administration, all exhibited early peripheral enhancement and partial centripetal isodense fill-in. None became completely isodense on delayed scans. Familiarity with these CT characteristics and a high index of suspicion should facilitate correct diagnosis and avert needle biopsy.
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