Hemorrhagic necrosis due to peliosis hepatis: imaging findings and pathological correlation

Peliosis hepatis is an uncommon liver condition characterized by blood-fill ed cavities. We report the CT, angiographic and MR features of a case of pe liosis hepatis with no obvious etiology and spontaneously regressing hemorr hagic necrosis. Helical CT showed multiple peripheral low-density regions w ith foci of spontaneous high density suggesting the presence of blood compo nent. On MR imaging, the multiple peripheral lesions were hypointense on T1 -weighted and hyperdense on T2-weighted images, with bright foci on all seq uences suggesting subacute blood. Angiography showed no evidence of tumor o r vascular malformation: multiple nodular vascular lesions filling in the p arenchymal phase and persisting in the venous phase suggested blood-filled cavities. Pathological examination showed blood-filled spaces with no endot helial lining, characteristic of the parenchymal type of peliosis. Knowledg e of the imaging features of hemorrhagic necrosis due to peliosis hepatis i s important since it can be responsive to antibiotic therapy. Furthermore, differentiating hemorrhagic necrosis from hepatic abscess avoids dangerous and sometimes fatal percutaneous drainage.