Though haemangioma is the most common benign neoplasm of the liver, giant haemangiomas which reach a size of > 4 cm are rare [1, 2]. Nevertheless, some authors point out the size of giant hemangioma to be over 6 cm . Giant haemangiomas come into attention of physicians when they become symptomatic and cause various symptoms from slight abdominal discomfort to spontaneous rupture, a life-threatening complication . Hepatic haemangiomas are diagnosed mainly by using non-invasive diagnostic procedures such as US, CT and MRI .
Radiologic findings for typical hepatic haemangioma are well known. On CT it’s a hypodense lesion with peripheral, globular enhancement during arterial phase, centripetal progression of enhancement during venous phase, which continues during delayed phase. Small hepatic haemangiomas can enhance homogeneously. On MRI it’s a well-defined lesion that has high signal intensity on T2-weighted images and gadolinium intake similar to the intake of iodinated contrast material during enhanced CT .
In certain patients the case is significant clinically due to the presence of abdominal pain in the right upper quadrant and is interesting because of the size of the tumour (about 9 cm), extensive “flame-shaped” peripheral enhancement, feeding arteries, incomplete opacification during delayed phase and rim of peritumoral oedema. Whereas “flame-shaped” enhancement is described in the literature, it is mostly grouped up with globular enhancement pattern and is not presented with discrete illustrations, which along with incomplete opacification due to thrombosis during delayed phase can lead to uncertainty in diagnosis. A presence of feeding vessels, peritumoral oedema and high signal intensity on T2-weighted images should be differentiated from hepatic adenoma . Differential diagnosis with hepatic capillary haemangioma lies in the angiographic pattern of enhancement, when pooling, which is characteristic of cavernous haemangioma, is not seen .