J Korean Soc Radiol.  2011 Feb;64(2):173-177. 10.3348/jksr.2011.64.2.173.

A Case Report of Multiple Cavernous Hemangiomas with Fluid-Fluid Levels: A Focus on the Radiologic Features of Dynamic MRI with Subtraction

• Lee WJ
• Kim G
• Lee JB
• Lee HY

• KMID: 2097934
• DOI: http://doi.org/10.3348/jksr.2011.64.2.173

Abstract

Multiple cavernous hemangiomas with fluid-fluid levels were presented in a 40-year-old male patient. These hemangiomas showed nonspecific radiologic features on ultrasound and computed tomography, but gadolinium-enhanced magnetic resonance imaging (MRI) with subtraction revealed fluid-fluid levels with unique and different enhancement of the inferior and superior layer. This is the first case report of cavernous hemangiomas with fluid-fluid levels, containing radiologic features of dynamic MRI with subtraction.

MeSH Terms

Adult
Caves
Hemangioma
Hemangioma, Cavernous
Humans
Liver Neoplasms
Magnetic Resonance Imaging
Male
Subtraction Technique

Figure

• 

  Fig. 1 A 40-year-old man with three hepatic hemangiomas with fluid-fluid levels. A. US shows a well-defined homogeneously hyperechoic nodule in the right lobe of liver. No fluid-fluid levels were demonstrated for all three lesions. B. Dynamic contrast enhanced CT at portal phase shows well-defined low density nodules with layered attenuation differences, which suggest fluid-fluid levels.

• 

  Fig. 2 MRI of the largest hemangioma with a fluid-fluid level. A. Heavily T2-weighted MR image (TR/TE, 1200/462) obtained in the supine position clearly depicts a fluid-fluid level within the hemangioma. B. On prone position, the heavily T2-weighted MR image shows the shift of the fluid-fluid level. C. T1-weighted 3D dynamic MR image without enhancement shows a low signal intensity (SI) nodule with a fluid-fluid level. The superior layer shows lower SI than the inferior layer. D-F. Subtraction MR images obtained 1, 3, and 10 min after injection of contrast medium shows centripetal globular enhancement of the inferior layer (arrow). The superior layer shows subtle enhancement on the 3 min delayed image (arrowhead in E) and gradual filling on the 10 min (arrowhead in F) delayed image. There is a time gap of enhancement between the two layers.

• 

  Fig. 3 Photomicrograph shows dilated vascular spaces lined by a single layer of endothelial cells (arrowheads) and separated by connective tissue, which is a typical finding of a cavernous hemangioma (H & E, ×200).

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