Peliosis hepatis (PH) is a rare benign pathological entity characterised by dilatation of the hepatic sinusoids. It has been reported to be associated with infection or malignancy, but the aetiology of PH remains unknown. Distinguishing PH from other malignancies can be difficult on imaging studies. This case report describes the incidental finding of PH in a patient undergoing a cardiac computed tomography (CT) scan at our institution. The CT scan incidentally revealed areas of altered density in the liver on the abdominal scans, requiring detailed liver diagnostic studies for better characterisation.

Peliosis hepatis (PH) is a rare benign vascular condition characterized by sinusoidal dilatation and the presence of blood-filled spaces within the liver. PH is often clinically asymptomatic and is discovered incidentally. It presents a clinical challenge as its imaging findings frequently mimic other pathologies, including primary or secondary malignancies and abscesses. In this article, we present a case of a 73-year-old woman with a history of recurrent tongue cancer treated by surgery and chemoradiotherapy, and concurrent multiple myeloma, in whom PH was incidentally discovered. Based on computed tomography, magnetic resonance imaging, and 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) imaging findings prior to biopsy, PH was diagnosed, and pathologically confirmed. Follow-up computed tomography five months after the discontinuation of raloxifene hydrochloride, a selective estrogen receptor modulator and a suspected drug causing PH, the regression of PH lesions was observed.

Non-neoplastic tumor-like conditions of the liver can appear similar to hepatic neoplasms. In many cases, a biopsy is required to confirm the pathology. However, several tumor-like conditions can be correctly diagnosed or suggested prospectively, thus saving patients from unnecessary anxiety and expense. In this image-focused review, we present the ultrasound, computed tomography, magnetic resonance imaging, and positron emission tomography scan features of eight such entities. Clues that indicate the correct pathology are discussed, and the usual clinical setting is described. Many of these lesions are treated differently from true neoplasms, and the current treatment plan is discussed in many of the cases presented. After reviewing this article, the reader will have a better understanding of these lesions and the situations in which they should be included in the differential diagnosis.

Peliosis hepatis (PH) and sclerosing angiomatoid nodular transformation of the spleen are uncommon benign lesions. Diagnosis can be difficult in some patients. Herein, we present the case of a 28-year-old woman referred with abdominal pain who had spleen lesions. 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography revealed multiple non-FDG avid lesions in the liver and hypermetabolic lesions in the spleen. In addition, abdominal magnetic resonance imaging was performed. Histopathology revealed sclerosing angiomatoid nodular transformation in the spleen and PH in the liver.
Peliosis hepatis (PH) ve dalağın sklerozan anjiomatoid nodüler transformasyonu nadir görülen benign lezyonlardır. Bazı olgularda tanısı zor olabilir. Bu olguda karın ağrısı şikayeti ile başvuran 28 yaşında, multipl dalak lezyonları saptanan hastayı sunuyoruz. 18F-florodeoksiglikoz (FDG) pozitron emisyon tomografisi/bilgisayarlı tomografide, karaciğerde çok sayıda FDG tutulumu göstermeyen lezyonlar ve dalakta hipermetabolik lezyonlar izlendi. Ayrıca hastaya batın manyetik rezonans görüntüleme yapıldı. Histopatolojik inceleme ile dalakta sklerozan anjiomatoid nodüler transformasyon ve karaciğerde PH saptandı.

Rare and sometimes fatal, spontaneous hepatic rupture (SHR) is frequently documented in conjunction with various benign and malignant hepatic tumors, peliosis hepatis (PH), amyloidosis, and polyarteritis nodosa. PH is a rare disease characterized by the presence of sinusoidal dilation and blood-filled cysts throughout the hepatic parenchyma. Handling and identifying this condition can be challenging, particularly in the absence of a history of liver cirrhosis or a tumor. The present case involves a 61-year-old male with a SHR and PH, accompanied by a significant history of end-stage renal disease (ESRD) over the past year. The patient presented to the emergency department with a three-week history of right flank pain. Hemoglobin levels were found to be low; the Glasgow Coma Scale (GCS) score was progressively decreasing. A computed tomography (CT) scan revealed a rupture of the right liver capsule, hemoperitoneum, PH, and an edematous gall bladder. The current case illustrates the diagnosis and management of PH and hemoperitoneum. This case emphasizes the challenging diagnosis of this potentially fatal liver complication in an outwardly healthy male, highlighting the connection between PH and ESRD.

BACKGROUND: Oxaliplatin-based regimens are commonly used as adjuvant chemotherapy following surgery for colorectal cancer. Adverse events associated with oxaliplatin include blue liver, which is caused by sinusoidal dilation and diffuse peliosis hepatis. We report herein a case of localized peliosis hepatis closely resembling a metastatic liver tumor.
METHODS: The patient, a 50-year-old male, underwent a robotically assisted colectomy for rectosigmoid colon cancer, which was discovered when hematochezia occurred. The patient received a diagnosis of pStage IIIb and was treated with four courses of CAPOX as adjuvant chemotherapy starting at postoperative month 1. At postoperative month 4, contrast-enhanced computed tomography (CT) of the abdomen revealed a 20-mm, low-density area with heterogeneous internal structure in S6/7 of the liver. Abdominal ultrasound and gadolinium ethoxybenzyl-diethylenetriaminepentaacetic acid-enhanced magnetic resonance imaging (EOB-MRI) findings led to a diagnosis of metastatic liver tumor, for which a laparoscopic partial hepatectomy was performed. The resected lesion was a dark reddish-brown nodule with indistinct margins that appeared to be continuous with the surrounding area. Histopathological analysis revealed severe, localized dilatation of the sinusoids and congestion consistent with the gross nodule. Based on these findings, localized peliosis hepatis associated with oxaliplatin-induced sinusoidal damage was diagnosed.
CONCLUSIONS: Localized peliosis hepatis associated with oxaliplatin use can be difficult to distinguish from a metastatic liver tumor on imaging studies.

In this series of articles on comments and illustrations of the World Federation for Medicine and Biology (WFUMB) guidelines on contrast-enhanced ultrasound (CEUS), the topics on very rare focal liver lesions (FLL) are discussed. This article describes the diverse changes of focal liver lesions in peliosis hepatis and the typical changes in porphyria. Although the focus is on the appearance on ultrasound and CEUS, the clinical context is always considered. While peliosis may be a surprising finding on puncture, lesions in porphyria cutanea tarda may be typical visual diagnoses that obviate the need for biopsy. If only you knew. This article aims to sharpen the clinician\'s eye. It provides knowledge of the clinical presentation and US and CEUS imaging of peliosis hepatis and porphyria.

Peliosis hepatis (PH) is a rare benign condition, characterized by hepatic sinusoidal dilatation and blood-filled cystic cavities, often found incidentally, with still challenging diagnosis by imaging due to polymorphic appearance.
Based on a retrospective analysis of our series (12 patients) and systematic literature review (1990-2022), to organize data about PH and identify features to improve characterization.
Retrospective case series and systematic review.
Twelve patients (mean age 48 years, 55% female) with pathology-proven PH and 49 patients (mean age 52 years, 67% female) identified in 33 studies from the literature (1990-2022).
1,5-T; T1-weighted (T1W), T2-weighted (T2W), diffusion-weighted (DW), contrast-enhanced (CE) T1W imaging.
We compared our series and literature data in terms of demographic (gender/age/ethnicity), clinical characteristics (symptoms/physical examination/liver test), associated conditions (malignancies/infectious/hematologic/genetic or chronic disorders/drugs or toxic exposure) percentage. On magnetic resonance imaging lesion numbers/shape/mean maximum diameter/location/mass effect/signal intensity were compared. PH pathological type/proposed imaging diagnosis/patient follow-up were also considered.
Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Case Reports/Series quality assessment. Intraclass correlation and Cohen\'s kappa coefficients for levels of inter/intrareader agreement in our experience.
Patients were mainly asymptomatic (92% vs. 70% in our study and literature) with associated conditions (83% vs. 80%). Lesions showed homogeneous T1W-hypointensity (58% vs. 65%) and T2W-hyperintensity (58% vs. 66%). Heterogeneous nonspecific (25% vs. 51%), centrifugal (34% vs. 8%), or rim-like centripetal (25% vs. 23%) patterns of enhancement were most frequent, with hypointensity on the hepatobiliary phase (HBP), without restricted diffusivity. Good inter- and intrareader agreement was observed in our experience. Concerning JBI Checklist, 19 out of 31 case reports met at least 7 out of 8 criteria, whereas 2 case series fulfilled 5 and 6 out of 10 items respectively.
A homogeneous, not well-demarcated T1W-hypointense and T2W-hyperintense mass, with heterogeneous nonspecific or rim-like centripetal or centrifugal pattern of enhancement, and hypointensity on HBP, may be helpful for PH diagnosis. Among associated conditions, malignancies and drug exposures were the most frequent.
4 TECHNICAL EFFICACY: Stage 2.

Peliosis hepatis remains a rare focal liver lesion with inconclusive imaging features. The unknown pathogenesis represents a wide possible range of etiologies including the breakdown of the sinusoidal borders, a potential hepatic outflow obstruction or dilatation of the central vein of a hepatic lobule. In histopathology, a blood-filled cystlike appearance with sinusoidal dilatation was reported. On ultrasound, B-mode features are not specific demonstrating a irregular, moreover hypoechogenic focal liver lesions. Postcontrast imaging features on Contrast-Enhanced-Ultrasound may mimic a malignant lesion with irregular contrast inflow and washout during late phase. Our case demonstrates a peliosis hepatis with malignant image features on contrast-enhanced ultrasound, ruled out by PET-CT and core needle biopsy with corresponding histopathological workup.

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