This Site EP is a 69 year old man being evaluated for lung cancer. Incidental liver mass found on CT and ultrasound. Usually asymptomatic, but can cause abdominal pain if large. Incidental lesions in the liver are often found on ultrasound or CT while searching for other pathology. Thus, the radiologist must determine the etiology of the mass in the most specific yet least invasive way available.
Cavernous hemangiomas are one of the most common lesions.
Currently, one of the most common clinical applications for radionuclide imaging of the liver is to characterize cavernous hemangiomas. These lesions are deficient in Kupffer cells and have low rates of blood flow but a large blood volume. The radionuclide findings are highly specific although some isolated false-positive examinations have been reported. This is due to the lack of blood volume contrast marker for use with CT, the existing contrast agents being too rapidly eliminated through the kidneys to permit consistent opacification of lesions by equilibration of the contrast in the vascular space. Larger lesions, rather arbitrarily designated as giant hemangiomas, may require images at delays greater than 1 hour to permit equilibration of the labelled red blood cells throughout the locally expanded red cell space.