Case 72: Hemangioma (infantile)
10 day old boy with high output heart failure. Abdominal ultrasound (not shown) demonstrated a mixed cystic and solid appearing liver mass.
Axial CT images show a large infantile hemangioma (formerly hemangioendothelioma) within the right lobe of the liver fed by branches of the right hepatic artery. On the arterial phase images the mass demonstrates peripheral, nodular, discontinuous enhancement that has slightly more filling in on the portal venous phase. On the 10 minute delayed, equilibrium phase, there is actually a decreased amount of the peripheral enhancement. Vascular components follow blood pool enhancement, typical for the vascular origin of the mass (compare to aorta). The central portion of the mass demonstrates no enhancement although there are crossing vessels through this area.
Of note, but not shown, on the arterial phase images, there was venous filling of enlarged hepatic veins as well as a large vein draining directly into the IVC. This is consistent with arterial-venous shunting through the mass.