PMC4529641_01
Dynamic computed tomography (axial view) revealing a giant liver mass with peripheral nodular enhancement during venous/delayed phase:and a large unenhanced cystic component.
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On dynamic CT the mass exhibited progressive nodular enhancement; however it was very heterogeneous containing diffuse large unenhanced cystic components and lacked evidence of centripetal fill-in (Fig. 1).
Dynamic computed tomography (coronal view) in venous/delayed phase, revealing a giant heterogeneous liver mass extending from the diaphragm to the pubis, and involving the left lobe and right anterior section of the liver.
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It involved the majority of the liver:sparing only the right posterior section, and extended down into the pelvis (Fig. 2).
View of giant liver hemangioma upon entering the abdomen. Note massive size as well as pedunculated feature allowing to eviscerate out of the wound, as it was free from hilar and other abdominal structures.
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On exploration, despite the massive size of the GH, it was found to be pedunculated and free from the hilar structures allowing for safe dissection (Fig. 3).
Surgical specimen:left trisectionectomy, revealing a giant cavernous hemangioma measuring 30 cm (after arterial inflow control). The specimen weighed 2934 g.
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The trunk of the middle and left hepatic veins was isolated and transected, in the form of an anatomic left trisectionectomy, although a significant portion of uninvolved right liver parenchyma was preserved (Fig. 4).
CT scan 9 months after resection revealing staple line at the area of transection of the middle and left hepatic veins, and hypertrophied right posterior section of the liver.
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Recent follow-up CT scan performed for prostate cancer surveillance revealed adequate hypertrophy of the liver and no evidence of residual or recurrent hemangioma (Fig. 5).