Imaging spectrum of giant hepatic hemangioma with diffuse hepatic hemangiomatosis: nine case series

초록

Background and aims: Giant hepatic hemangioma accompanied by diffuse hepatic hemangiomatosis is a rare entity in adults and can mimic infiltrative hepatic malignancies. While individual case reports have described its imaging characteristics, larger case series remain limited. This study aims to summarize the radiologic features and clinical characteristics of patients with giant hemangioma and coexisting diffuse hepatic hemangiomatosis. Method: A retrospective radiologic database search was performed using the keyword “diffuse hepatic hemangiomatosis.” Thirteen adult patients with imaging findings suspicious for diffuse hepatic hemangiomatosis were identified. Clinical information, laboratory data, contrast-enhanced CT, multiphasic liver MRI, and available pathology reports were reviewed. Imaging features—including enhancement patterns, lesion distribution, and associated hepatic abnormalities—were systematically analyzed. Results: A total of 13 patients met the imaging criteria for diffuse hepatic hemangiomatosis. Among them, 9 patients had both CT and MRI available for comprehensive radiologic evaluation. Typical imaging findings included peripheral nodular enhancement with progressive fill-in in giant hemangiomas and innumerable small T2- hyperintense nodules consistent with diffuse hepatic hepatic hemangiomatosis. Pathologic confirmation was obtained in 3 patients, all demonstrating cavernous hemangioma or hemangiomatosis without evidence of malignancy. However, one of them subsequently required an additional hepatectomy due to progression of diffuse hepatic hemangiomatosis. Follow-up imaging demonstrated overall stability in the majority of cases. Conclusion: This case series highlights characteristic radiologic findings of giant hepatic hemangioma with diffuse hemangiomatosis in adults. Recognition of this pattern is essential to avoid misdiagnosis as infiltrative malignancy. CT and MRI provide complementary diagnostic information, and pathology—though not always required— can confirm the vascular benign nature. Conservative management appears appropriate in patients with preserved liver function and stable imaging features.