Cavernous haemangioma

Images and text Genevieve Carbonatto

An abdominal ultrasound is performed on a young woman for right upper quadrant pain. This is what is seen while scanning through the liver

This is a cavernous haemangioma. It looks like a snowball on ultrasound.

Characteristics of haemangiomas:

  • Blood filled cavernous space lined with a single layer of flat endothelial cells and seperated by fibrous septa.
  • Usually less than 3 cm
  • Uniformly hyperechoic
  • May be associated with  acoustic enhancement
  • Common and benign affecting 0.5 – 20% of the general population
  • Found mainly in 30 -40 year olds
  •  3 -5 X more frequent in women
  • May be multiple in 10 -50% of cases
  • May be found anywhere but they are usually peripheral and subcapsular in the posterior segments of the right lobe
  • Asymtomatic if small. If over 5 cm they may cause inflammation causing rapid tumour growth associated with fever, weight loss and abdominal pain
  • Colour Doppler will not show slow moving blood in the sinuses. If Doppler flow is readily detectable then this is a concerning feature.

In a young patient without any malignancy or risk factors, the typical ultrasound features of a cavernous haemagioma requires no follow up.

 

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