PMC2626703_01
Abdominal ultrasonogram shows a huge and heterogeneous lesion at the subcapsular area of the right hepatic lobe (arrows) and also a perihepatic fluid collection.
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F1
The ultrasound examination performed on an ATL machine (HDI 5000, Bothell, WA) revealed a huge and heterogeneous lesion at the subcapsular area of the right hepatic lobe and also a perihepatic fluid collection (Fig. 1).
The triphasic, contrast-enhanced CT scan shows irregular and linear, septa-like densities (arrow) in the unenhancing, hypodense mass-like lesion at segment 8, which are isodense to liver parenchyma on the arterial (A), portal venous (B) and delayed (C) phases.
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F2
Most of the lesion was not enhanced, but multiple, irregular and linear, septa-like densities were demonstrated which were of isoattenuation to the adjacent normal parenchyma on all phases (Fig. 2).
The unenhanced CT scan shows massive acute hematoma in the right subcapsular area (A, arrows). The triphasic, contrast-enhanced CT scan shows small enhancing focus (arrow) on the background of hemorrhage, which is isodense to liver parenchyma on the arterial (B), portal (C) and delayed (D) phases. Note a small lesion in the right lobe (arrowhead) that is hypodense on the arterial phase (B), peripherally enhanced on the portal venous phase (C), and it becomes totally isodense or slightly hyperdense on the delayed phase (D).
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F3
The unenhanced images also revealed a huge, heterogeneous and mainly hyperdense lesion occupying the entire right subcapsular area, and this was suggestive of acute hematoma (Fig. 3A). Another 1 cm-sized lesion was seen at the right hepatic lobe, and the lesion was of low density on the arterial phase; it showed peripheral isodense enhancement on the portal venous phase and it became totally isodense or slightly hyperdense on the delayed phase (Fig. 3).
Coronal reconstruction image shows a necrotic mass-like lesion at the dome (arrow) and a small enhancing focus in the hematoma (thin arrow) as well as massive hemorrhage that occupies the entire right subcapsular area (arrowheads).
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F4
The MPR images helped us view all the above-mentioned findings at a glance (Fig. 4).
Celiac angiogram shows an irregular parenchymal defect in the hepatic dome (arrows) and a huge hypovascular area that is displacing the right lobe: this suggests subcapsular hematoma (arrowheads).
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F5
The angiogram revealed a huge hypovascular area that conformed to the entire right subcapsular portion, which was compatible with hematoma, and an irregular parenchymal defect was seen in the hepatic dome without any feeding vessels, definite contrast accumulations or vascular malformations (Fig. 5).
A photomicrograph reveals a blood-filled cavity lined by fibrinous materials and hepatocytes (H & E stain, x40).
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F6
On microscopic examination, the lesion was diagnosed as peliosis hepatis which was a blood filled cavity lined by fibrinous material and hepatocytes (Fig. 6).