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Imaging of multifocal liver lesions in children and adolescents.

Hegde SV, Dillman JR, Lopez MJ, Strouse PJ - Cancer Imaging (2013)

Bottom Line: Multifocal liver lesions are encountered regularly in children and adolescents.By knowing the specific ultrasonographic, computed tomographic, and magnetic resonance imaging (MRI) features of benign and malignant pediatric liver lesions as well as the particular clinical setting, radiologists can frequently narrow the differential diagnosis and sometimes offer a definitive diagnosis.The purpose of this review article is to illustrate the imaging findings of numerous benign and malignant causes of multifocal liver lesions in the pediatric population.

View Article: PubMed Central - PubMed

Affiliation: Section of Pediatric Radiology, Department of Radiology, University of Michigan Health System, Ann Arbor, MI, USA.

ABSTRACT
Multifocal liver lesions are encountered regularly in children and adolescents. By knowing the specific ultrasonographic, computed tomographic, and magnetic resonance imaging (MRI) features of benign and malignant pediatric liver lesions as well as the particular clinical setting, radiologists can frequently narrow the differential diagnosis and sometimes offer a definitive diagnosis. The purpose of this review article is to illustrate the imaging findings of numerous benign and malignant causes of multifocal liver lesions in the pediatric population.

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Related in: MedlinePlus

A 9-month-old girl with hepatomegaly and numerous infantile hepatic hemangiomas. (a) Color Doppler image through the left lobe of the liver shows multiple predominantly hypoechoic circumscribed masses with adjacent increased vascularity. (b,c) Axial T1-weighted and T2-weighted fast spin echo fat-saturated images reveal numerous circumscribed T1-weighted hypointense and T2-weighted hyperintense liver lesions. (d,e) Axial arterial phase and coronal delayed phase T1-weighted three-dimensional spoiled gradient recalled fat-saturated postcontrast MR images show early peripheral enhancement of the lesions with complete central fill-in over time.
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Figure 6: A 9-month-old girl with hepatomegaly and numerous infantile hepatic hemangiomas. (a) Color Doppler image through the left lobe of the liver shows multiple predominantly hypoechoic circumscribed masses with adjacent increased vascularity. (b,c) Axial T1-weighted and T2-weighted fast spin echo fat-saturated images reveal numerous circumscribed T1-weighted hypointense and T2-weighted hyperintense liver lesions. (d,e) Axial arterial phase and coronal delayed phase T1-weighted three-dimensional spoiled gradient recalled fat-saturated postcontrast MR images show early peripheral enhancement of the lesions with complete central fill-in over time.

Mentions: Infantile hepatic hemangiomas are benign mesenchymal tumors composed of numerous thin-walled vascular channels and intervening fibrous stroma and that are GLUT1 immunoreactive[1,8]. These lesions can be associated with cutaneous as well as other vascular lesions (e.g., airway)[1,9], and they are usually diagnosed under 6 months of age[9]. Infantile hepatic hemangiomas frequently enlarge rapidly and then spontaneously regress, and 50% or more of cases are multifocal based on the literature (Figs. 5 and 6)[1]. It is possible that many solitary focal infantile hepatic hemangiomas reported in the past are actually rapidly involuting congenital hemangiomas (RICHs), a GLUT1 negative lesion. Hepatic hemangiomas (as well as other vascular lesions, such as Kaposiform hemangioendotheliomas and tufted angiomas) occurring during the infantile period have been associated with congestive heart failure from arteriovenous shunting of blood flow, bleeding tendency due to consumptive coagulopathy (Kasabach-Merritt syndrome), hypothyroidism due to increased levels of type 3 iodothyronine deiodinase, abdominal compartment syndrome, and fulminant hepatic failure[1,10,11].Figure 5


Imaging of multifocal liver lesions in children and adolescents.

Hegde SV, Dillman JR, Lopez MJ, Strouse PJ - Cancer Imaging (2013)

A 9-month-old girl with hepatomegaly and numerous infantile hepatic hemangiomas. (a) Color Doppler image through the left lobe of the liver shows multiple predominantly hypoechoic circumscribed masses with adjacent increased vascularity. (b,c) Axial T1-weighted and T2-weighted fast spin echo fat-saturated images reveal numerous circumscribed T1-weighted hypointense and T2-weighted hyperintense liver lesions. (d,e) Axial arterial phase and coronal delayed phase T1-weighted three-dimensional spoiled gradient recalled fat-saturated postcontrast MR images show early peripheral enhancement of the lesions with complete central fill-in over time.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3569672&req=5

Figure 6: A 9-month-old girl with hepatomegaly and numerous infantile hepatic hemangiomas. (a) Color Doppler image through the left lobe of the liver shows multiple predominantly hypoechoic circumscribed masses with adjacent increased vascularity. (b,c) Axial T1-weighted and T2-weighted fast spin echo fat-saturated images reveal numerous circumscribed T1-weighted hypointense and T2-weighted hyperintense liver lesions. (d,e) Axial arterial phase and coronal delayed phase T1-weighted three-dimensional spoiled gradient recalled fat-saturated postcontrast MR images show early peripheral enhancement of the lesions with complete central fill-in over time.
Mentions: Infantile hepatic hemangiomas are benign mesenchymal tumors composed of numerous thin-walled vascular channels and intervening fibrous stroma and that are GLUT1 immunoreactive[1,8]. These lesions can be associated with cutaneous as well as other vascular lesions (e.g., airway)[1,9], and they are usually diagnosed under 6 months of age[9]. Infantile hepatic hemangiomas frequently enlarge rapidly and then spontaneously regress, and 50% or more of cases are multifocal based on the literature (Figs. 5 and 6)[1]. It is possible that many solitary focal infantile hepatic hemangiomas reported in the past are actually rapidly involuting congenital hemangiomas (RICHs), a GLUT1 negative lesion. Hepatic hemangiomas (as well as other vascular lesions, such as Kaposiform hemangioendotheliomas and tufted angiomas) occurring during the infantile period have been associated with congestive heart failure from arteriovenous shunting of blood flow, bleeding tendency due to consumptive coagulopathy (Kasabach-Merritt syndrome), hypothyroidism due to increased levels of type 3 iodothyronine deiodinase, abdominal compartment syndrome, and fulminant hepatic failure[1,10,11].Figure 5

Bottom Line: Multifocal liver lesions are encountered regularly in children and adolescents.By knowing the specific ultrasonographic, computed tomographic, and magnetic resonance imaging (MRI) features of benign and malignant pediatric liver lesions as well as the particular clinical setting, radiologists can frequently narrow the differential diagnosis and sometimes offer a definitive diagnosis.The purpose of this review article is to illustrate the imaging findings of numerous benign and malignant causes of multifocal liver lesions in the pediatric population.

View Article: PubMed Central - PubMed

Affiliation: Section of Pediatric Radiology, Department of Radiology, University of Michigan Health System, Ann Arbor, MI, USA.

ABSTRACT
Multifocal liver lesions are encountered regularly in children and adolescents. By knowing the specific ultrasonographic, computed tomographic, and magnetic resonance imaging (MRI) features of benign and malignant pediatric liver lesions as well as the particular clinical setting, radiologists can frequently narrow the differential diagnosis and sometimes offer a definitive diagnosis. The purpose of this review article is to illustrate the imaging findings of numerous benign and malignant causes of multifocal liver lesions in the pediatric population.

Show MeSH
Related in: MedlinePlus