Imaging and Clinical Management of Peliosis Hepatis

Peliosis hepatis is a rare, benign vascular condition of the liver characterised by blood-filled cavities that vary in size and distribution. Often asymptomatic, it is typically discovered incidentally during imaging or surgical procedures. The aetiology encompasses chronic immunosuppression, anabolic steroid use, oestrogen therapy, infections such as Bartonella, and underlying malignancies. Imaging plays a pivotal role in diagnosis and differentiation from malignancies or abscesses, employing modalities such as ultrasound, computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET/CT). Characteristic features include heterogeneous enhancement patterns, sinusoidal dilatation and, in severe cases, capsular rupture leading to haemoperitoneum. Clinical management ranges from conservative observation and withdrawal of precipitating agents to interventional radiology techniques and surgical resection in patients with haemorrhage or persistent lesions. Regular follow-up imaging is advised to monitor lesion regression or progression. Improved recognition of imaging hallmarks and tailored management algorithms has reduced misdiagnosis and unwarranted invasive procedures, underscoring the global importance of multidisciplinary care in optimising outcomes for patients with this uncommon condition.

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Imaging and Clinical Management of Peliosis Hepatis publication trend

The graph below shows the total number of articles in imaging and clinical management of peliosis hepatis across all publications each year (not limited to Nature Index journals).

Technical terms

Computed tomography (CT): cross-sectional X-ray imaging technique providing high-resolution views of internal structures.

Magnetic resonance imaging (MRI): imaging method using magnetic fields and radiofrequency pulses to generate detailed soft-tissue contrast.

18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET/CT): combined metabolic and anatomical imaging modality that detects radiolabelled glucose uptake in tissues.

Contrast-enhanced ultrasound (CEUS): ultrasound technique using microbubble contrast agents to assess vascularity and perfusion.

Sinusoidal dilatation: expansion of hepatic sinusoids leading to blood-filled spaces characteristic of peliosis hepatis.

References

1. A unique presentation of peliosis hepatis: A case report and comprehensive review of the literature. International Journal of Hepatobiliary and Pancreatic Diseases (2023).
2. Spontaneous Hepatic Rupture in the Setting of Peliosis Hepatis and End-Stage Renal Disease. Cureus (2023).
3. Imaging findings of a case of peliosis hepatis mimicking malignancies. Radiology Case Reports (2024).
4. Longitudinal CT, MRI, and 18F-FDG PET/CT Imaging Findings of Peliosis Hepatis: A Case Report. Cureus (2024).