Hepatic epithelioid hemangioendothelioma (HEH) is a rare malignancy of mesenchymal origin with a low to an intermediate grade and an unknown etiology. Definitive diagnosis of HEH requires histopathologic confirmation and the imaging findings associated with these tumors is often misleading as reported by several authors. Since its imaging characteristics resembles more frequent disease (e.g. metastasis), the HEH should be always considered in the differential of diffuse infiltrating masses of the liver. Our purpose was to describe the CT and MR appearances of this tumor with a particular focus on the application of the diffusion weighted imaging and the hepatobiliary contrast agent.
On December 2014, a 35 years old woman was received at our radiology department, with non-specific symptoms including right upper quadrant pain, hepatomegaly and weight loss. She also reported a previous Ultrasonography (US) where the liver was found with diffuse heterogeneous pattern, hyper/isoechoic pseudo nodular areas, mainly on the peripheral region.