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What happened to my liver lesion (Hepatic Sclerosed Hemangioma)? Let's not forget (radiological) history

Journal Volume 82 - 2019
Issue Fasc.4 - Clinical images
Author(s) M. Renzulli, N. Capozzi, A. Clemente, F. Tovoli, S. Cappabianca, R. Golfieri
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(1) Radiology Unit, Department of Experimental, Diagnostic and Speciality Medicine, Sant'Orsola Hospital, University of Bologna, Bologna, Italy ; (2) Radiology and Radiotherapy Unit, Department of Precision Medicine, University of Campania “L. Vanvitelli”, Naples, Italy ; (3) Unit of Internal Medicine, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy..

A 68-year-old man with a medical history of hyper- tension, dyslipidemia, ischemic stroke, benign prostatic hyperplasia and hepatic steatosis underwent liver magnetic resonance imaging (MRI) in our Institution. Laboratory tests showed increased cholesterol levels and normal liver function. Six months before, an abdominal ultrasound (US), in a context of hepatomegaly and hepatosteatosis, demonstrated a hypoechoic 2 cm lesion in liver segment VII, with regular margins. Contrast-enhanced US showed slight peripheral enhancement during the entire acquisition time. Due to its features not pathognomonic for a typical lesion, the patient underwent liver MRI performed with gadolinium-ethoxybenzyl-diethylenetriaminepentaacetic acid (Gd-EOB-DTPA), a hepatobiliary contrast agent. On MRI, the 2-cm lesion in liver segment VII showed heterogeneous signal intensity in both T1- and in T2- weighted images. In particular, strongly hyperintensity on heavily T2-weighted sequence typical of hemangioma (Fig. 1A), and diffuse and homogenous signal dropout on opposed-phase T1-weighted images (Fig. 1B) compared to in-phase T1-weighted images (Fig. 1C), pathognomonic for steatotic adenoma were absent. After administration of the contrast agent, a slight rim enhancement (Fig. 1D) and the EOB cloud sign on the hepatobiliary phase (Fig. 1E) were identified. Moreover, the lesion demonstrated hyperintensity in the diffusion- weighted image (Fig. 1F). Is it possible to reach diagnosis without previous imaging examinations?

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PMID 31950819