Liver hemangioma mimicking cholangiocarcinoma--a diagnostic dilemma.
A 55-year-old man presented with a liver mass that had been diagnosed on ultrasonography, carried out in response to the patient's complaint of non-specific abdominal pain. Triphasic computed tomography (CT) revealed a lesion involving segments 1, 4, 5 and 8 of the liver. It was centrally hypodense with peripheral enhancement in the arterial phase suggesting a cholangiocarcinoma. The middle hepatic vein was encased and the tumour was present near the junction of the left hepatic and middle hepatic veins. We planned a right hepatic trisegmentectomy including resection of the caudate lobe but since the estimated volume of the liver remnant was only 17% of the total, we first embolised the right portal vein. CT scan repeated 5 weeks later revealed that the lesion was still resectable and that the left lateral segment had hypertrophied to 27% of the liver volume. We performed a right trisegmentectomy including caudate lobe resection using intra-operative ultrasonography to establish that the left hepatic vein was not involved. The removed lesion was hard with ill-defined margins. Histopathological examination revealed a hemangioma.
Sood
Disha
D
Department of Surgical Gastroenterology & Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, India.
Kumaran
Vinay
V
Buxi
T B S
TB
Nundy
Samiran
S
Soin
Arvinder Singh
AS
D001650:Bile Duct Neoplasms / Q000175:diagnosis* / Q000628:therapy; D001653:Bile Ducts, Intrahepatic / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000175:diagnosis* / Q000628:therapy; D003937:Diagnosis, Differential; D004621:Embolization, Therapeutic / Q000379:methods; D006391:Hemangioma / Q000175:diagnosis* / Q000628:therapy; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D014057:Tomography, X-Ray Computed / Q000379:methods