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Hepatic hemangiomas are the most common type of benign liver tumors. We present a case of an infected hepatic hemangioma, which posed a diagnostic challenge. A 43-year-old female presented with right upper quadrant pain after blunt force trauma and intentional weight loss. CT and MRI were done, showing a posterior right lobe liver mass. Imaging characteristics were thought to be suggestive of metastatic disease, with a differential diagnosis of abscess. Drainage and biopsy of the mass revealed Streptococcus sp. infection, and pathology showed a cavernous hemangioma with inflammation. Patients presenting with systemic symptoms and an indeterminate liver mass on imaging should be evaluated for infected hepatic hemangiomas. Biopsy may be needed to rule out cancer. Management may include surgical resection; however, antibiotics and percutaneous drainage can suffice, as in this case.

Imaging Characteristics and Management of Infected Hepatic Hemangioma: Case-in Discussion