Magnetic resonance imaging of chronic bleeding into a giant hepatic hemangioma

Hepatic hemangiomas are the most common benign mesenchymal hepatic tumors. They are usually asymptomatic and most of them are discovered incidentally during an imaging test performed for various indications. However, spontaneous intratumoral bleeding or rupture is possible and usually occurs in large hemangiomas that are peripherally located. In this paper, we present a case of a patient with an asymptomatic bleeding into hepatic hemangioma. Reviewing the literature we found no reports on accidental finding of bleeding with absence of clinical symptoms. Intratumoral bleeding in hepatic hemangioma is suggested by presence of high density areas within the tumor on nonenhanced CT images and high signal intensity areas on T1-weighted MR images, best depicted on fat-suppressed sequences. Presence of typical enhancement features of hemangioma and marked high signal intensity on T2-weighted sequences in spared nonhemorrhagic areas allow the specific diagnosis. In this paper we describe changes that occur in hepatic hematomas during long follow-up period using magnetic resonance imaging.