From the Guidelines
No monitoring is required for this 64-year-old man with small simple hepatic cysts in segments 4 and 6 measuring 0.6 cm. Simple hepatic cysts are benign lesions that typically follow an indolent course without significant changes in size over time, as stated in the EASL clinical practice guidelines on the management of cystic liver diseases 1. When cysts are small (less than 1 cm), asymptomatic, and have typical benign features on ultrasound (well-defined, anechoic, thin-walled), they do not require follow-up imaging or intervention. The guidelines explicitly state that there is no indication for follow-up of simple hepatic cysts whatever the size 1, and it is not recommended to follow asymptomatic patients because of simple hepatic cysts 1. These lesions are present in approximately 2.5-18% of the general population and rarely cause clinical problems. The natural history of simple hepatic cysts is that most remain stable or grow very slowly over time. Only if the patient develops symptoms such as abdominal pain, or if future imaging for other reasons shows significant growth or concerning features (internal septations, mural nodules, or wall thickening), would further evaluation be warranted. Key points to consider include:
- Simple hepatic cysts are benign and do not require follow-up imaging or intervention if asymptomatic and small
- Ultrasound should be the first diagnostic modality used if symptoms occur in patients with simple hepatic cysts 1
- Routine follow-up with imaging after aspiration sclerotherapy or surgical procedures for hepatic cysts is not recommended 1 The patient can be reassured that these findings are benign and do not require any specific treatment or surveillance.
From the Research
Diagnosis and Management of Simple Hepatic Cysts
- Simple hepatic cysts are typically saccular, thin-walled masses with fluid-filled epithelial lined cavities, and are frequently detected in clinical examinations using ultrasonography (US) 2.
- The American College of Gastroenterology clinical guidelines recommend laparoscopic fenestration for symptomatic simple hepatic cysts due to its high success rate and low invasiveness 2.
- Asymptomatic simple hepatic cysts do not require treatment, and therapeutic abstention with or without iconographic monitoring constitutes the optimal management of many benign liver cysts without clinical repercussions 3.
Monitoring of Simple Hepatic Cysts
- For asymptomatic simple hepatic cysts, monitoring is not always required, but it may be necessary to differentiate them from neoplasms and infections 2, 3.
- Imaging with conventional ultrasound, computed tomography, magnetic resonance imaging, or contrast-enhanced ultrasound can be used to further characterize and diagnose hepatic cysts 4, 5, 6.
- In the case of a 64-year-old man with a small simple cyst (0.6 cm) in hepatic segments 4 and 6, monitoring may not be necessary if the cyst is asymptomatic and has no suspicious features on ultrasound 2, 3.
Characteristics of Simple Hepatic Cysts
- Simple cysts are mainly congenital cysts, but also occur in polycystic liver disease, and are characterized by the absence of septae, mural nodularity, calcifications, and debris 4, 5, 6.
- The size and shape of the cyst, the presence and thickness of a cyst wall, and the presence of communication with the biliary tree are important features to recognize in the diagnosis of simple hepatic cysts 6.