From the Guidelines
No routine monitoring is required for a 64-year-old man with small simple hepatic cysts measuring 0.6 cm in segments 4 and 6. Simple hepatic cysts are benign, fluid-filled structures that are common incidental findings on abdominal imaging, occurring in approximately 2-18% of the population [ 1 ]. When cysts are small (less than 1 cm), asymptomatic, and have typical features of simple cysts on ultrasound (anechoic, thin-walled, round lesions without internal echoes or septations), they can be safely left alone without follow-up imaging.
Key Points to Consider
- The patient's cysts are small and asymptomatic, which reduces the likelihood of significant growth or symptoms [ 1 ].
- The European Association for the Study of the Liver (EASL) clinical practice guidelines recommend against routine follow-up for asymptomatic patients with simple hepatic cysts [ 1 ].
- Ultrasound is the modality of choice for diagnosing simple hepatic cysts, and CT and MRI are not indicated for further characterization [ 1 ].
- If the patient develops symptoms such as right upper quadrant pain, abdominal distension, or other concerning symptoms in the future, reassessment would be warranted [ 1 ].
- Routine surveillance is unnecessary for asymptomatic small simple cysts with classic benign features, as intervention is only indicated for symptomatic cysts or those with atypical features raising concern for other diagnoses [ 1 ].
From the Research
Hepatic Cysts Diagnosis and Management
- Hepatic cysts are frequently discovered incidentally on abdominal imaging, with a prevalence of 15-18% in the United States 2.
- Simple cysts are mainly congenital cysts, but also occur in polycystic liver disease, and are typically characterized by the absence of septae, mural consistency, calcifications, and specific quality of cystic fluid 2, 3.
- The diagnosis of hepatic cysts can be made using imaging modalities such as conventional ultrasound, computed tomography, magnetic resonance imaging, or contrast-enhanced ultrasound 2, 3, 4.
Monitoring Requirements
- For simple cysts, monitoring is not always required, especially if they are small and asymptomatic 2, 3.
- However, complex cysts or those with suspicious features may require further evaluation and monitoring to rule out malignant or premalignant conditions 2, 5, 6.
- In the case of a 64-year-old man with a hepatic segment 4 and six small simple cysts noted on ultrasound measuring 0.6 cm, monitoring may not be necessary unless the cysts are symptomatic or show suspicious features 2, 3.
Imaging Modalities
- Ultrasound is typically the first-line imaging modality for diagnosing hepatic cysts, while more advanced imaging modalities such as computed tomography, magnetic resonance imaging, or contrast-enhanced ultrasound can help narrow down the specific lesion 2, 3, 4.
- Magnetic resonance imaging (MRI) is a reliable diagnostic tool for hemorrhagic hepatic cysts, which can be difficult to differentiate from other neoplastic entities on imaging 5.