Ultrasonographic and computed tomography features of peliosis hepatis mimicking malignant hepatic neoplasia in two cats

Peliosis hepatis is a vascular disorder characterized by multifocal, blood-filled cavities within the hepatic parenchyma and may closely mimic malignant hepatic disease on diagnostic imaging. In cats, the imaging characteristics of peliosis hepatis have been poorly documented, particularly in cases complicated by acute hemorrhage. This report describes the ultrasonographic and computed tomographic findings of peliosis hepatis in 2 cats presenting with acute anemia and hemoperitoneum. In both cases, ultrasonography revealed multiple cyst-like hepatic lesions with heterogeneous echogenicity, hyperechoic rims, and central hypoechoic to anechoic components. Multi-phase contrast-enhanced computed tomography identified multifocal hypoattenuating hepatic lesions, some showing peripheral rim or centripetal enhancement with a minimal mass effect, raising a strong suspicion of primary or metastatic hepatic neoplasia. Subcapsular hematomas and high-attenuation perihepatic fluid were consistent with hemorrhage. A histopathological examination confirmed peliosis hepatis in both cats, characterized by extensive parenchymal hemorrhage and fibrin deposition without evidence of neoplasia. Despite the intensive supportive care and surgical intervention, both cats died from severe anemia secondary to hepatic rupture. These cases highlight that peliosis hepatis should be included in the differential diagnosis of multifocal hepatic lesions and spontaneous hemoperitoneum in cats. Moreover, they emphasize the importance of histopathological confirmation to avoid a misdiagnosis of malignant hepatic disease.