Flash filling hepatic hemangioma
Updates to Article Attributes
Flash filling hepatic venous malformations, also known as flash filling hepatic haemangiomas, are a type of atypical hepatic venous malformation (haemangioma), which due to its imaging features often raises the concern of a malignant process rather than a benign one.
Terminology
It is important to note that according to newer nomenclature (ISSVA classification of vascular anomalies) these lesions are merely known as slow flow venous malformations. Having said that it is probably helpful in reports to include the word 'hemangioma' as this term is ubiquitous in the literature and most familiar to many clinicians. The remainder of this article uses the terms 'flash filling hemangioma' and 'flash filling hepatic venous malformation' interchangeably.
Epidemiology
They may account for 16% of all hepatic haemangiomas 3.
Pathology
Being a subtype of hepatic haemangioma, it is also composed of dilated endothelial lined vascular channels and fibrous stroma.
Radiographic features
Most are small in size (<2 cm).
Ultrasound
On ultrasound, most are hyperechoic - same as the typical haemangiomas.
CT
On CT, these lesions are normally iso- to hypo-dense on unenhanced scans. There is a quick, brilliant and homogeneous enhancement of the lesion in the arterial phase itself, hence the name "flash filling". In the rest of the phases, it retains the contrast and remains isodense to the adjacent vascular pool.
MRI
- T1: hypointense
- T2: markedly hyperintense
- C+ (Gd): prompt enhancement but no washout
Other general features
At times the venous matrix of these haemangiomas may develop phleboliths, which when recognised should be promptly associated with haemangioma.
Differential diagnosis
Due to the atypical feature of quick, brilliant arterial phase enhancement, these lesions have to be differentiated from:
- hepatocellular carcinoma
- hypervascular hepatic metastases (renal cell carcinoma, thyroid carcinoma, neuroendocrine tumour, choriocarcinoma, melanoma, breast carcinoma and leiomyosarcoma)
- focal nodular hyperplasia
See also
-<p><strong>Flash filling hepatic venous malformations</strong>, also known as <strong>flash filling hepatic haemangiomas</strong>, are a type of <a href="/articles/atypical-hepatic-venous-malformation">atypical hepatic venous malformation</a> (haemangioma), which due to its imaging features often raises the concern of a malignant process rather than a benign one. </p><h4>Terminology</h4><p>It is important to note that according to newer nomenclature (<a href="/articles/issva-classification-of-vascular-anomalies">ISSVA classification of vascular anomalies</a>) these lesions are merely known as slow flow venous malformations. Having said that it is probably helpful in reports to include the word 'hemangioma' as this term is ubiquitous in the literature and most familiar to many clinicians. The remainder of this article uses the terms 'flash filling hemangioma' and 'flash filling hepatic venous malformation' interchangeably. </p><h4>Epidemiology</h4><p>They may account for 16% of all hepatic haemangiomas <sup>3</sup>.</p><h4>Pathology</h4><p>Being a subtype of <a href="/articles/hepatic-haemangioma-3">hepatic haemangioma</a>, it is also composed of dilated endothelial lined vascular channels and fibrous stroma.</p><h4>Radiographic features</h4><p>Most are small in size (<2 cm). </p><h5>Ultrasound</h5><p>On ultrasound, most are hyperechoic - same as the typical haemangiomas. </p><h5>CT</h5><p>On CT, these lesions are normally iso- to hypo-dense on unenhanced scans. There is a quick, brilliant and homogeneous enhancement of the lesion in the arterial phase itself, hence the name "flash filling". In the rest of the phases it retains the contrast and remains isodense to the adjacent vascular pool. </p><h5>MRI</h5><ul>- +<p><strong>Flash filling hepatic venous malformations</strong>, also known as <strong>flash filling hepatic haemangiomas</strong>, are a type of <a href="/articles/atypical-hepatic-venous-malformation">atypical hepatic venous malformation</a> (haemangioma), which due to its imaging features often raises the concern of a malignant process rather than a benign one. </p><h4>Terminology</h4><p>It is important to note that according to newer nomenclature (<a href="/articles/issva-classification-of-vascular-anomalies">ISSVA classification of vascular anomalies</a>) these lesions are merely known as slow flow venous malformations. Having said that it is probably helpful in reports to include the word 'hemangioma' as this term is ubiquitous in the literature and most familiar to many clinicians. The remainder of this article uses the terms 'flash filling hemangioma' and 'flash filling hepatic venous malformation' interchangeably. </p><h4>Epidemiology</h4><p>They may account for 16% of all hepatic haemangiomas <sup>3</sup>.</p><h4>Pathology</h4><p>Being a subtype of <a href="/articles/hepatic-haemangioma-3">hepatic haemangioma</a>, it is also composed of dilated endothelial lined vascular channels and fibrous stroma.</p><h4>Radiographic features</h4><p>Most are small in size (<2 cm). </p><h5>Ultrasound</h5><p>On ultrasound, most are hyperechoic - same as the typical haemangiomas. </p><h5>CT</h5><p>On CT, these lesions are normally iso- to hypo-dense on unenhanced scans. There is a quick, brilliant and homogeneous enhancement of the lesion in the arterial phase itself, hence the name "flash filling". In the rest of the phases, it retains the contrast and remains isodense to the adjacent vascular pool. </p><h5>MRI</h5><ul>
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