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Unusual cause of a left hypochondria pain: pedunculated giant haemangioma of the liver
  1. Sami Kouki1,
  2. Imen Helal1 and
  3. Mehdi Ben Lassoued2
  1. 1 Radiology Department, Military Hospital of Tunis, Faculty of Medecine, University of Tunis El Manar, Tunis, Tunisia
  2. 2 Emergency Department, Military Hospital of Tunis, Faculty of Medecine, University of Tunis El Manar, Tunis, Tunisia
  1. Correspondence to Sami Kouki, koukisemi{at}yahoo.fr

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Description

A 26-year-old woman with no medical or surgical history presented with abdominal pain in the left hypochondria without any other symptoms. The patient underwent ultrasound that showed a well-defined mass of the left hypochondria, heterogeneous measuring 9 cm. The lesion seems independent of the spleen and liver. We completed by an MRI of the abdomen. Contrast-enhanced MRI demonstrated a mass of the left hypochondria, well demarcated, measuring 9 cm with low signal of intensity on T1 (figure 1) and a high intensity on T2 (figure 2) with peripheral progressive nodular enhancement, which progresses centripetally in delayed images (figure 3). The homogenisation of the lesion was seen on late sequences. A pedicle connected the lesion to the segment II of the liver. A second lesion measuring 2 cm with similar MRI feature is located in the segment VII of the liver. Otherwise, the liver was homogeneous. These aspects are consistent with the diagnosis of pedunculated giant haemangioma of the liver extending in the left hypochondria.

Figure 1

MRI, transversal plane, well-defined left hypochondria with low signal on T1-weighted image (arrow).

Figure 2

MRI, transversal plane, well-defined left hypochondria with high signal on T2-weighted image (arrow).

Figure 3

MRI, transversal and coronal planes, gadolinium-enhanced T1-weighted image. Well- defined mass with peripheral progressive centripetally enhancement originating from segment II of the liver (arrow).

Pedunculated haemangiomas with exophytic growth are extremely rare. To date, only 20 cases of such pedunculated giant haemangiomas of the liver have been reported in the literature.1

In cases of typical haemangiomas, imaging modalities are highly reliable for diagnosis, especially MRI, which has a sensitivity and specificity of greater than 90%.2 According to the literature, ultrasound, CT and MRI detection rates for hepatic haemangiomas are 57–90, 5%, 73%–92.2% and 97%, respectively.3

Learning points

  • Pedunculated giant haemangioma of the liver is extremely rare.

  • Exophytic growth of hepatic haemangioma especially in left hypochondria is rare.

  • Pedunculated hepatic haemangioma with exophytic growth should be evoked in case of left hypochondria mass.

Acknowledgments

The authors would like to acknowledge Pr Ben Abdallah, Head of Radiology Department.

References

Footnotes

  • Contributors SK: patient observation. IH: figures. MBL: bibliography.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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