LAUSR

© BMJ Publishing Group Limited 2022. No commercial reuse. See rights and permissions. Published by BMJ. DESCRIPTION Haemangioma is the most common benign hepatic tumour of the liver; despite being common, sclerosing haemangioma is a rare entity with a female predominance. Based on their imaging features, an atypical haemangioma can be distinguishable from malignancy. Factors responsible for haemangioma degeneration are increased degree of fibrosis, scar formation and thrombosis of its vascular channels, which is called a sclerosing or hyalinising haemangioma, which can lead to its end stage where it is completely sclerosed or hyalinised. 3 These sclerosing haemangiomas are asymptomatic and are therefore often incidentally found. The process of sclerosis changes the radiologic characteristics of these haemangiomas. Subsequently, it renders their reliable diagnosis using only imaging characteristics nearly impossible as sclerosing haemangiomas have an imaging appearance that makes them indistinguishable from malignancy, such as metastasis, hepatocellular carcinoma or cholangiocarcinoma. CT is characterised by a lack of early enhancement on dynamic contrastenhanced CT images and may or may not demonstrate degrees of peripheral enhancement in the late phase; thus, it is difficult to definitively differentiate hyalinised haemangioma from malignant hepatic tumours. The surgical approach for resection of hepatic sclerosing haemangioma is controversial. Most of the previously reported tumours were resected due to preoperative misdiagnosis as hepatic malignancies. Percutaneous needle biopsy is not considered adequate because of the possibility of disseminating cancer cells if the tumour is malignant. A woman in her 60s came to the emergency with a complaint ofreported upper abdominal pain and vomiting for the past few days. Her physical examination shows no localised sign of pathology. Vitals were unremarkable, and the patient was conscious of time, place and person. The patient