(A) Noncontrast CT demonstrates a hypodense mass in the medial segment (segment 3) of the left lobe of the liver (circle). (B,C) Two-hour–delayed anterior planar and axial SPECT images of the abdomen from a Tc99m-RBC scan demonstrate a corresponding focus of increased activity (circles).

Differential Diagnosis

•  Cavernous hemangioma: Focally increased RBC accumulation on delayed blood pool imaging is virtually pathognomonic for this entity.

•  Angiosarcoma: This can reportedly have the same appearance but is exceedingly rare.

•  Focal nodular hyperplasia: This is the second most common benign tumor of the liver but is cold on an RBC scan (often hot on SCOL and HIDA).

Essential Facts