Case 67:   Hemangioendothelioma, epithelioid (adult)

Diagnostic Category:

Clinical Presentation:

Patient with incidental liver lesion

CT: Typical, with fibrotic rim enhancement

Imaging Findings:

Multiphase CT shows biopsy proven epithelioid hemangioendothelioma (EHE) in segment 8: mass demonstrates continuous but weak arterial rim enhancement and stronger more peripheral rim enhancement on equilibrium phase, typical for fibrotic tissue components. The lesion is attached to the liver capsule, which is typical, but without causing the typical capsular retraction. Non-enhancing components are necrotic.

One smaller mass is more medially located in segment 8. Note the bright dot sign, misleading to the diagnosis of hemangioma, but progressive enhancement on equilibrium phase is slightly denser than adjacent blood vessel, indicating the fibrotic nature of this small EHE focus and excluding cavernous hemangioma.

Compare to another lesion of the same patient here.