Case 154:   Angiosarcoma

Clinical Presentation:

46 year old man with history of a cardiac neoplasm

CT: Ruptured, partly mimicking hemangiomatosis

Imaging Findings:

Ten months after resection of a 4 cm primary angiosarcoma of the right atrium of the heart (not shown) CT demonstrates numerous metastases in the non-cirrhotic liver and spleen. Most of the liver metastases are round, hypodense, and show strong eccentric or peripheral ringlike or discontinuous hypervascular enhancement following blood pool density. Lesions with bright dot sign or discontinuous peripheral enhancement are morphologically difficult to differentiate from hemangiomata, while ringlike enhancement is more suspicious for malignancy. Note the transient hypervascularity distal to the larger metastasis in the right lobe ("siphon" effect).

The largest metastasis in the left lobe ruptured; note hypersende perihepatic fluid. The patient expired four months later (14 months after primary diagnosis).