DOI: https://doi.org/10.36347/sasjs.2026.v12i11.006

Pages: 923-928

Background. Hepatic cavernous hemangioma is the most common benign liver tumor, while focal nodular hyperplasia (FNH) is the second most common. Both are usually distinguished on cross-sectional imaging, but a hemangioma that has undergone internal remodeling thrombosis, fibrosis, hyalinization, and hemorrhage may lose its characteristic features and closely simulate FNH, leading to diagnostic uncertainty. Case presentation. A 26-year-old man with no significant medical history presented with a six-month history of late postprandial vomiting and no other associated symptoms. Physical examination revealed a soft, non-tender abdomen with no palpable mass. Contrast-enhanced CT showed a hypervascular mass of hepatic segment I with exophytic extension toward the hilum, measuring 11.5 × 10 × 9 cm and compressing adjacent vascular structures; the morphological and kinetic features were reported as compatible with FNH. Liver MRI confirmed a large lobulated process without a clearly individualized capsule in the left liver, isointense on T1 and T2, with strong arterial enhancement and portal-phase homogenization, and a central scar that was hypointense on T1, hyperintense on T2, and showed faint delayed enhancement again interpreted as FNH. The patient underwent surgical resection of the exophytic inter-hepatogastric mass arising from segment I (Spiegel lobe). Histopathology demonstrated a benign hepatic vascular lesion consistent with a remodeled cavernous hemangioma, with no evidence of malignancy. Conclusion. A remodeled giant hepatic hemangioma can mimic FNH on both CT and MRI, particularly when a central scar and atypical enhancement are present. A central scar is not specific to FNH and should be interpreted with caution. Histopathological examination remains the definitive arbiter when imaging is inconclusive or when a large, symptomatic, or anatomically complex lesion warrants resection.