Gradual spontaneous regression of hepatic hemangioma in a woman with surgical menopause: A decade of imaging follow-up

Hepatic hemangiomas (HHs), the most common benign liver tumors, may grow, remain stable, or rarely regress spontaneously, with regression potentially associated with reduced estrogen levels. We report a 67-year-old woman with a large HH exhibiting gradual regression (∼3 mm/year) over a decade of imaging post-surgical menopause in 2010, without hormone replacement therapy. Serial computed tomography (CT) and ultrasound (US) from 2014 to 2025 showed an initial 5.4 cm lesion, hypoechoic on US due to early-stage (F0-F1) metabolic dysfunction-associated steatotic liver disease (MASLD; Fibrosis-4 index <1.3) but with classic CT features (discontinuous peripheral nodular enhancement, centripetal fill-in). By 2025, the lesion regressed in size to ∼2 cm, and loss of previously seen regions of enhancement suggesting sclerosing. This case highlights gradual HH regression years after menopause, emphasizes multimodal imaging for MASLD-related US atypia, and supports conservative management for asymptomatic cases.