PMC3023038_01
a Initial abdominal CT at presentation in 2003 showing the largest lesion (18.1 x 15.9 cm) measured at level of the right portal vein and the second largest lesion was 4.3 x 3.5 cm. b Initial chest CT in 2003 revealing innumerable pulmonary nodules. c Video-assisted thoracoscopic surgery (VATS). Diffuse hemorrhagic, purple/red, raised nodules are seen on the surface of the lung. Biopsy of these lesions revealed benign cavernous hemangiomas. d Photomicrograph of an H&E-stained section of cavernous hemangioma in a lung biopsy specimen (40x). The lung lesions were small and well-circumscribed with benign endothelial cells and thin vessel walls and septa composed predominantly of fibrous tissue.
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Fig1
CT scan of the abdomen and chest showed numerous, large hypervascular liver masses, the largest measuring 18 x 23 cm (Fig. 1a), splenic hemangiomas, as well as innumerable bilateral pulmonary nodules (Fig. 1b). Given the multiorgan presentation raising concern for a metastatic neoplasm, the patient underwent video-assisted thoracoscopic surgery which demonstrated diffuse, purple, raised, subpleural nodules (Fig. 1c). The lung biopsy demonstrated pulmonary cavernous hemangiomas (Fig. 1d).
a Intra-operative photo prior to start of liver transplantation demonstrating the patient's massive abdominal distension. b Giant cavernous hepatic hemangioma occupying the entire abdominal cavity. c Posterior aspect of gross liver specimen following resection and complete decompression (the white ruler on the specimen measures 15 cm in length and is on top of the left lobe). d Intra-operative photo at the completion of liver transplantation demonstrating the patient's abdomen.
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Fig2
Her exam was significant for markedly increased abdominal distension (Fig. 2a). The liver occupied her entire abdomen, the majority of which showed the appearance of a massive cavernous hemangioma (Fig. 2b). The liver was excised (Fig. 2c), and the donor allograft was brought to the operative field. Following completion of the liver transplant (Fig. 2d), the patient was extubated in the operating room and transferred to the intensive care unit.