# A Diagnostic Challenge: Sclerosed Hepatic Haemangioma Mimicking Malignancy

## TL;DR

An elderly patient's liver lesion was initially suspected to be cancerous but was diagnosed as a benign sclerosed haemangioma after a biopsy.

## Contribution

This case emphasizes the diagnostic challenge of distinguishing benign sclerosed haemangiomas from liver malignancies in elderly patients.

## Key findings

- Imaging alone can be misleading in diagnosing sclerosed haemangiomas as malignant liver lesions.
- Liver biopsy and multidisciplinary discussion are crucial for accurate diagnosis in complex cases.
- Conservative management is appropriate for benign lesions with comorbidities.

## Abstract

A 75-year-old lady presented to Accident and Emergency (A&E) with acute worsening shortness of breath and new palpitations. On assessment, she was found to have fast atrial fibrillation, signs of heart failure, and bilateral peripheral oedema. Investigations revealed pulmonary embolism and an incidental hepatic lesion on CT imaging, suspicious for malignancy. Multidisciplinary discussion led to liver biopsy, which confirmed a benign sclerosed haemangioma. The patient was managed conservatively for cardiac and thromboembolic complications. This case highlights the difficulty in differentiating sclerosed haemangiomas from malignant liver lesions on imaging alone and underscores the importance of biopsy and multidisciplinary decision-making in elderly patients with comorbidities. Learning points include diagnostic vigilance, safe management of anticoagulation, and avoidance of unnecessary surgery.