Thoracic CT imaging revealing hemorrhagic pulmonary metastases with a ground-glass halo sign was pivotal in diagnosing primary hepatic angiosarcoma in a 64-year-old man with chronic liver disease.
Case Report (n=1)
In patients with atypical hepatic masses, the presence of hemorrhagic pulmonary nodules with a CT halo sign should prompt consideration of a vascular malignancy such as hepatic angiosarcoma.
We report the case of a 64-year-old man with chronic liver disease who presented with abdominal discomfort, anorexia, and progressive weight loss, initially suspected to have hepatocellular carcinoma based on a large hepatic mass lacking definitive radiologic hallmarks. Multiphase CT demonstrated heterogeneous peripheral enhancement without classical washout, while thoracic imaging revealed numerous bilateral pulmonary nodules surrounded by ground-glass halos, indicating hemorrhagic metastases. These thoracic findings proved pivotal in directing diagnostic suspicion toward a vascular neoplasm. Ultrasound-guided liver biopsy confirmed high-grade hepatic angiosarcoma, with tumor cells showing ERG positivity and weak CD31 expression, and lacking hepatocellular or epithelial markers. The patient experienced rapid clinical deterioration with intrapulmonary hemorrhage, multiorgan dysfunction, and refractory shock, culminating in death shortly after diagnosis. This case highlights the diagnostic complexity of hepatic angiosarcoma and underscores the importance of integrating thoracic imaging with hepatic evaluation, particularly when liver findings are atypical.
P et al. (Mon,) conducted a case report in Primary hepatic angiosarcoma (n=1). Thoracic CT imaging revealing hemorrhagic pulmonary metastases with a ground-glass halo sign was pivotal in diagnosing primary hepatic angiosarcoma in a 64-year-old man with chronic liver disease.