case_images: PMC8416894_01
case_images: (A) MRI of the liver shows lobulated lesions in the subcapsular aspect of segments 2, 7, and 8 of the liver (white arrows). The largest lesion is located at segment 7, its size is ~86 x 81 x 81 mm, and it is closely related to the liver segments of the right hepatic vein and IVC. The size of the lesion in S2 is ~54 x 44 x 41 mm. The hemangiomas on MRI appear hyperintense on DWI (a) and T2WI (b,c) and hypointense on T1WI (d-g) sequences. On post-contrast dynamic imaging, the lesion demonstrates discontinuous peripheral nodular enhancement on the arterial phase (e) with incomplete centripetal fill-in on the delayed phase (d,f). The findings are consistent with hepatic hemangiomas. (B) Comparing the cross-sectional CT (a) and coronal (b) reformatted CT images with those of MRI images on March 16, 2014, primary multiple hemangiomas in the liver were significantly shrunk, and their boundaries were not clear. The size of the giant hemangioma in segment 7 of the liver was decreased to 44 x 28 mm, with unclear borders and nodular high-density shadows inside it. The lesions are closely related to the liver segments of the right hepatic vein and IVC.
case_images: fmed-08-712324-g0001.jpg
case_images: PMC8416894_01_fmed-08-712324-g0001.jpg
case_images: F1
case_images: AFP, CEA, tumor-associated carbohydrate antigens (CA125 and CA199) and rheumatism-related indicators, were all within the normal limits. Abdominal MRI showed well-defined, smooth edges and homogeneous, solid, round-like lesions originating from the second to eighth segments of the right lobe of the liver (Figure 1A). In November 2017, abdominal CT before kidney transplant surgery showed that the original multiple HHs in his right liver were blurred in outline and shape, and the size of the largest HH was reduced to 44 mm x 28 m, with an obscure outline, uneven internal echo, normal internal blood vessels, and plaque-like hyperechoic shadows behind it (Figure 1B).
case_images: Ultrasound showing multiple hemangiomas (white arrows) that appear as echogenic nodular lesions on grayscale ultrasound (a) and non-vascular lesions on color Doppler ultrasound (b). The size of the largest segment located in the S7 segment on US performed in June 2015 (A: 76 x 61 mm) is nearly as large as that on US performed in March 2013 (according to the US report without images, 75 x 62 mm). Ultrasound images in May 2017 (B), May 2018 (C) and May 2021 (D) show that most of the multiple hepatic hemangiomas are not clearly displayed, the largest hemangioma in the S7 segment is still visible (The size described in ultrasound report performed in May 2018 is 43 x 26 mm), and calcified plaques can be seen inside.
case_images: fmed-08-712324-g0002.jpg
case_images: PMC8416894_01_fmed-08-712324-g0002.jpg
case_images: F2
case_images: During hospitalization, ultrasound examination reported multiple hemangiomas in his liver, and the largest hemangioma located in segment 7 was 76 x 61 mm in size (Figure 2A). In May 2017, Doppler ultrasound showed that his HHs were significantly smaller than before (56 mm x 26 m vs. 76 x 61 mm), with unclear outlines and shapes, strong echo points and normal internal blood vessels inside the lesions (Figure 2B). Results of abdominal ultrasound examination in May 2017 (Figure 2C) and May 2018 (Figure 2D) reported that the original HHs in the patient's liver were unclear.