From the Guidelines
No follow-up imaging is recommended for this 66-year-old female patient. The ultrasound findings reveal only benign hepatic cysts with internal septations but no solid components or vascularity, which are common incidental findings that do not require additional surveillance, as stated in the EASL clinical practice guidelines on the management of cystic liver diseases 1. The initial low-density nodules seen on the prior imaging correspond to these simple cysts. The geographic hypoechoic region adjacent to the hepatic hilum likely represents focal fat sparing, which is a normal variant of liver parenchyma in patients with fatty liver. The diffuse increased echogenicity noted is consistent with mild hepatic steatosis (fatty liver). According to the guidelines, simple hepatic cysts are benign lesions that typically follow an indolent course without significant changes in size over time 1. There is no indication for follow-up of simple hepatic cysts whatever the size, unless patients become symptomatic, in which case imaging (ultrasound first) will assess the size and look for complications and compression 1. Key points to consider in this patient's case include:
- The absence of solid hepatic lesions
- The presence of multiple cysts with internal septations but no solid components or internal vascularity
- The geographic hypoechoic region likely representing focal fat sparing
- The diffuse increased echogenicity consistent with mild hepatic steatosis If the patient develops new symptoms such as right upper quadrant pain, jaundice, or abnormal liver function tests in the future, then reassessment would be appropriate, but routine surveillance imaging is unnecessary for these benign findings.
From the Research
Follow-up Imaging Recommendations
The patient's condition, characterized by low-density nodules within both lobes of the liver and multiple cysts with internal septation, is suggestive of polycystic liver disease (PLD) 2, 3, 4. Given the presence of multiple cysts and the patient's age, follow-up imaging is recommended to monitor the progression of the disease.
Imaging Modalities
Various imaging modalities, including ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography-computed tomography (PET-CT), can be used to evaluate PLD 3, 5, 6. The choice of imaging modality depends on the specific clinical scenario and the need to assess liver function, cyst characteristics, and potential complications.
Monitoring Disease Progression
Regular follow-up imaging is essential to monitor the growth rate of liver cysts and assess the risk of complications, such as infection, hemorrhage, or liver dysfunction 3, 5. The use of height-adjusted liver cystic volume and height-adjusted liver volume can help classify liver progression and guide management decisions 5.
Key Considerations
When recommending follow-up imaging, the following factors should be considered:
- The patient's age and sex, as these can influence the growth rate of liver cysts 5
- The presence of symptoms or complications, such as infection or hemorrhage 3, 6
- The size and characteristics of the liver cysts, including the presence of internal septation or solid components 3
- The patient's overall health status and the potential need for surgical or medical intervention 2, 3