Korean J Radiol.  2007 Feb;8(1):64-69. 10.3348/kjr.2007.8.1.64.

Peliosis Hepatis with Hemorrhagic Necrosis and Rupture: a Case Report with Emphasis on the Multi-Detector CT Findings

• Kim EA
• Yoon KH
• Jeon SJ
• Cai QY
• Lee YW
• Yoon SE
• Yoon KJ
• Juhng SK

• KMID: 753867
• DOI: http://doi.org/10.3348/kjr.2007.8.1.64

Abstract

We report here on an uncommon case of peliosis hepatis with hemorrhagic necrosis that was complicated by massive intrahepatic bleeding and rupture, and treated by emergent right lobectomy. We demonstrate the imaging findings, with emphasis on the triphasic, contrast-enhanced multidetector CT findings, as well as reporting the clinical outcome in a case of peliosis hepatis with fatal hemorrhage.

Keyword

Liver, CT; Liver, diseases; Peliosis hepatis; Hemorrhage

MeSH Terms

Tomography, X-Ray Computed/*methods
Rupture
Peliosis Hepatis/complications/*radiography/surgery
Necrosis
Humans
Hemorrhage/etiology/*radiography/surgery
Female
Adult

Figure

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  Fig. 1 Abdominal ultrasonogram shows a huge and heterogeneous lesion at the subcapsular area of the right hepatic lobe (arrows) and also a perihepatic fluid collection.

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  Fig. 2 The triphasic, contrast-enhanced CT scan shows irregular and linear, septa-like densities (arrow) in the unenhancing, hypodense mass-like lesion at segment 8, which are isodense to liver parenchyma on the arterial (A), portal venous (B) and delayed (C) phases.

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  Fig. 3 The unenhanced CT scan shows massive acute hematoma in the right subcapsular area (A, arrows). The triphasic, contrast-enhanced CT scan shows small enhancing focus (arrow) on the background of hemorrhage, which is isodense to liver parenchyma on the arterial (B), portal (C) and delayed (D) phases. Note a small lesion in the right lobe (arrowhead) that is hypodense on the arterial phase (B), peripherally enhanced on the portal venous phase (C), and it becomes totally isodense or slightly hyperdense on the delayed phase (D).

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  Fig. 4 Coronal reconstruction image shows a necrotic mass-like lesion at the dome (arrow) and a small enhancing focus in the hematoma (thin arrow) as well as massive hemorrhage that occupies the entire right subcapsular area (arrowheads).

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  Fig. 5 Celiac angiogram shows an irregular parenchymal defect in the hepatic dome (arrows) and a huge hypovascular area that is displacing the right lobe: this suggests subcapsular hematoma (arrowheads).

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  Fig. 6 A photomicrograph reveals a blood-filled cavity lined by fibrinous materials and hepatocytes (H & E stain, ×40).

Reference

1. Zak FG. Peliosis hepatis. Am J Pathol. 1950. 26:1–15.

2. Wang SJ, Ruggles S, Vade A, Newman BM, Borge MA. Hepatic rupture caused by peliosis hepatis. J Pediatr Surg. 2001. 36:1456–1459.

3. Fidelman N, LaBerge JM, Kerlan RK Jr. SCVIR 2002 film panel case 4: massive intraperitoneal hemorrhage caused by peliosis hepatis. J Vasc Interv Radiol. 2002. 13:542–545.

4. Pliskin M. Peliosis hepatis. Radiology. 1975. 114:29–30.

5. Kleinig P, Davies RP, Maddern G, Kew J. Peliosis hepatis: central "fast surge" ultrasound enhancement and multislice CT appearances. Clin Radiol. 2003. 58:995–998.

6. Savastano S, San Bortolo O, Velo E, Rettore C, Altavilla G. Pseudotumoral appearance of peliosis hepatis. AJR Am J Roentgenol. 2005. 185:558–559.

7. Gouya H, Vignaux O, Legmann P, de Pigneux G, Bonnin A. Peliosis hepatis: triphasic helical CT and dynamic MRI findings. Abdom Imaging. 2001. 26:507–509.

8. Steinke K, Terraciano L, Wiesner W. Unusual cross-sectional imaging findings in hepatic peliosis. Eur Radiol. 2003. 13:1916–1919.

9. Vignaux O, Legmann P, de Pinieux G, Chaussade S, Spaulding C, Couturier D, et al. Hemorrhagic necrosis due to peliosis hepatis: imaging findings and pathological correlation. Eur Radiol. 1999. 9:454–456.

10. Yanoff M, Rawson AJ. Peliosis hepatis. An anatomic study with demonstration of two varieties. Arch Pathol. 1964. 77:159–165.