Case 160:   Angiosarcoma

Clinical Presentation:

30 year old man with acute onset of abdominal pain.

MR: Primary angiosarcoma after embolization, with metastases

Imaging Findings:

MR demonstrates a large embolized biopsy proven angiosarcoma of the right hepatic lobe in a cirrhotic liver.  Despite embolization of the right hepatic artery mass demonstrates gradual central enhancement on the later post contrast phases and follows blood pool enhancement proving coexisting portal venous blood supply of the mass, which is typical. This should not be puzzled with centripetal enhancement of giant cavernous hemangiomas. Mass also demonstrates small necrotic components, which were also present on CT prior to embolization.

Note numerous small hypervascular metastases in the left lobe and a sliver of peri-hepatic ascites and liquified hematoma. 

Embolized mass, small metastases and perihepatic ascites are hyperintense on T2.

Early arterial phase of right hepatic artery angiogram demonstrates typical numerous hypervascular foci within the tumor.