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This case is a 60-year-old gentleman who presented

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with right flank pain, got a non-contrast CT.

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That showed an indeterminate, uh, mass in the liver,

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and an MRI was suggested for further evaluation.

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So as we begin systematically approaching this, uh, liver

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mass, we'll start off with our T2-weighted sequences.

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And we can already see a very, very large mass

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occupying the majority of the right hepatic lobe

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and portions of the left hepatic lobe on our T2

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weighted sequence performed without fat saturation.

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These findings are re-demonstrated on the T2

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weighted imaging performed with fat saturation,

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and it's quite hyperintense on these images.

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The signal, uh, portions of it, I would

0:40

say, at least approximate the signal at CSF.

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And unlike the prior case, um, I would say that the

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T2 signal within this is relatively homogeneous.

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If you were to scroll up and down through

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this, uh, lesion, you don't see any of those,

0:53

um, clefts of slightly brighter T2 signal.

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So I'm just scrolling up and down here just

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to kind of showcase the extent of this lesion.

1:01

It's quite exophytic, and again, you're not seeing

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any of those clefts of bright T2 signal within this.

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Next set of images we need to look

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at are T1 in and out of phase images.

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On the in and out of phase images, we once again can

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see this large mass occupying majority of the right

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hepatic lobe, extending into the left hepatic lobe.

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On both the out of phase imaging sequence here and the

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in-phase imaging sequence, we can see that this lesion

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is pretty homogeneous and is T1 hypointense on both.

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There are no areas of, uh, decreased signal

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on the out of phase imaging sequence.

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It's just fat and no areas of, uh,

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signal loss in the in-phase images.

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Suggest, uh, content that can

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cause, um, susceptibility artifact.

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Next up is our T1 fat-saturated pre-contrast

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image, again showcasing this large mass.

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We can again see this mass, really, really big, it's, uh,

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pretty homogeneous and overall has T1 content that is

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hypointense, no areas of hyperintense T1 content within this.

2:00

Final set of images to look at are the post-contrast images

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that will help us determine what this is going to be.

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So we can see this on the arterial phase images.

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This lesion has areas of peripheral contrast enhancement.

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On the portal venous phase, those areas start

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to fill in a little bit more centrally, and

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even more so on the equilibrium phase images.

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So this again means imaging features of a hemangioma,

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and it's an example of a giant hemangioma because of

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its large size, certainly way more than 5 centimeters.

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And the reason I wanted to show this case

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is because This particular one does not

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have areas of internal cystic degeneration.

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That's where one of the prior cases of giant

2:42

hemangiomas had that, this doesn't have it.

2:44

They don't all have to have it, but by and large, uh,

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hemangiomas follow this sort of enhancement pattern.

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While hemangiomas, uh, are generally benign, and

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this lesion as well will be benign, because of the

2:56

large size, you may get some abdominal pain and

2:59

discomfort due to mass effect and, uh, potentially,

3:03

uh, coagulopathy due to Kasabach-Merritt syndrome.