Hepatic arteriovenous malformation demonstrating unusual findings on imaging study

Abstract

A 64-year-old woman was referred to our hospital for further examination of a liver mass which was identified with ultrasound. Liver function tests revealed normal, and tumor markers were negative. Ultrasound disclosed a hyperechoic lesion with hypoechoic area and tubular structures inside, along with irregular and obscure contour in the posterior segment of the liver. The lesion was demonstrated as a low density area on computed tomographic scan, which was not enhanced with contrast medium. On angiography and CT arteriography of the liver, the posterior inferior branch of the hepatic artery was enlarged and tortuous. There was prominent hypervascularity around the central hypovascular lesion. Moreover, early filling of hepatic veins and mottled capillary blush throughout the right lobe of the liver were noted. From these findings, we made a diagnosis of hepatic arteriovenous malformation based on hereditary hemorrhagic telangiectasia (HHT) or Rendu-Osler-Weber's disease. Our case has very unique findings on imaging study, compared with previous reports of hepatic arteriovenous malformation.