PMC6837789_01
Non-contrast computed tomography scan (a) showing a mass lesion which appears separated from the liver and is causing scalloping of the left lobe, closely abutting the lesser curvature of the stomach and appearing inseparable from it. Post-contrast arterial phase (b) shows patchy peripheral enhancement adjacent to the left lobe of the liver (arrow). Portovenous (c) and delayed (d) phases show progressive filling in of the lesion with contrast (arrows). The pattern of enhancement is suggestive of a haemangioma.
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F0001
Progressive filling in of the mass with contrast was noted in the venous and delayed phases with a few non-enhancing areas within it (Figure 1).
(a) Coronal reformat image shows the mass scalloping of the left lobe of the liver. (b) Sagittal reformat image shows the mass abutting a wide region of the lesser curvature of the stomach and appearing inseparable from it. However, close inspection shows a sliver of tissue (arrow) extending between the left lobe of the liver and the mass.
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F0002
On multiplanar reconstructions, the relationship of the mass to the adjacent organs was assessed and no definite claw sign was observed with any of them (Figure 2).
Arterial phase thin section reconstructions of the upper part of the mass (a) and (b) show a tortuous vessel with arterial flow within (arrow) passing from the left lobe of the liver into the mass through a thin sliver of tissue (pedicle). The adjoining part of the liver parenchyma also shows abnormal enhancement in the arterial phase. The vessel can be traced back to the left branch of the hepatic artery in successive images (c) and (d) (arrows).
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F0003
On close inspection, a few definite arterial vascular channels were identified from the left lobe of the liver passing into the mass through a sliver of tissue (pedicle) and supplying the mass in its uppermost part just subjacent to the diaphragm (Figure 3).
T1W image (a) reveals the mass to be hypointense with a cleft-like area of lower signal intensity within. The mass is brightly hyperintense on T2W (b) and SPAIR (c) suggestive of a light bulb sign with a cleft-like area of marked high signal intensity within signifying a hepatic haemangioma. Post-contrast scan (d) shows patchy peripheral enhancement. Dynamic contrast-enhanced scan (not shown) revealed centripetal enhancement with contrast from the arterial through the delayed phases.
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Further, dynamic contrast-enhanced MRI was performed which showed a similar pattern of enhancement in the arterial, portovenous and delayed phases as seen on MDCT angiography (Figure 4).
Grayscale ultrasound (a) shows the mass lesion scalloping the left lobe of the liver. Doppler examination (b) shows increased vascularity in the left lobe of the liver adjacent to the lesion with a tortuous bridging vessel (c) passing through a sliver of tissue from the left lobe to the mass (arrow). Doppler waveform (d) from the bridging vessel shows arterial flow.
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The bridging vessels between the liver and the mass were identified, with detectable arterial flow within them (Figure 5).
Post-operative histopathological slides of the mass with haematoxylin and eosin staining (a) and (b) show large, blood-filled cavernous vascular spaces separated by connective tissue stroma typical of cavernous haemangioma.
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The patient proceeded to surgery for removal of the haemangioma prior to renal donation, and histopathological examination of the mass confirmed the diagnosis of cavernous haemangioma (Figure 6).