Liver & intrahepatic bile ducts

Vascular disorders

Peliosis hepatis

Last author update: 8 January 2021
Last staff update: 4 October 2023

Copyright: 2003-2024,, Inc.

PubMed Search: Peliosis hepatis

Raul S. Gonzalez, M.D.
Page views in 2023: 3,774
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Cite this page: Gonzalez RS. Peliosis hepatis. website. Accessed July 13th, 2024.
Definition / general
  • Multiple blood filled cysts in liver, with several potential causes
Essential features
  • Blood filled hepatic spaces of various sizes, usually discovered by radiology or at autopsy
  • Several possible etiologies, including Bartonella henselae or B. quintana infection, which also cause spindle cell / vascular proliferation
  • Two types:
    • Peliosis hepatis refers to bland blood filled spaces of various etiologies
    • Bacillary peliosis refers to hepatic spindle cell proliferation with small blood vessels and blood filled spaces secondary to Bartonella infection
  • Peliosis should not be confused with lipopeliosis
  • Peliosis may occur in liver or spleen
Clinical features
  • May be asymptomatic or manifest as jaundice, portal hypertension, liver failure, liver rupture or hepatomegaly
  • Patients may also have liver or renal transplant, Castleman disease, nodular regenerative hyperplasia, leukemia / lymphoma (Arch Pathol Lab Med 2004;128:1283)
  • Usually incidental finding at autopsy
Radiology description
  • Blood filled spaces visible on imaging
  • Withdrawal of causative drug, if applicable
  • Erythromycin or doxycycline for Bartonella infections
Clinical images

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Blood filled spaces on CT

Gross description
  • Honeycomb liver with multiple round, red purple, blood filled spaces of varying sizes
Microscopic (histologic) description
  • Blood lakes of various sizes within the liver, which may be continuous
  • In phlebectatic subtype, spaces are lined by endothelium and central veins are dilated
  • In parenchymal subtype, spaces are not lined and parenchyma has variable hemorrhagic necrosis (Arch Pathol 1964;77:159)
  • May have calcifications (J Ultrasound Med 1996;15:257)
  • Background liver may show sinusoidal dilation
  • Bacillary peliosis may show angiomatosis, with spindle cell process accompanied by blood vessel proliferation
Microscopic (histologic) images

Contributed by @RaulSGonzalezMD on Twitter
Peliosis hepatis Peliosis hepatis

Peliosis hepatis

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Peliosis 1

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Peliosis 2

Positive stains
Sample pathology report
  • Liver, biopsy:
    • Liver parenchyma with large blood filled cystic spaces and background sinusoidal dilation (see comment)
    • Comment: The findings are compatible with peliosis hepatic, which has many potential etiologies. Trichrome and iron stains are unremarkable.
Differential diagnosis
Board review style question #1
    A 45 year old man presents to the emergency department complaining of abdominal pain but collapses and dies before receiving care. Autopsy shows several findings, including a liver studded with numerous blood filled lakes. Microscopically, these spaces are associated with a vascular / spindle cell proliferation. Which of the following other conditions did the patient likely have?

  1. Blue rubber bleb nevus syndrome
  2. Congestive heart failure
  3. Ganglioneuromatosis
  4. Hereditary hemorrhagic telangiectasia
  5. HIV infection
Board review style answer #1
E. HIV infection

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