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 imaging surveillance, as stated in the EASL clinical practice guidelines on the management of cystic liver diseases 1. The geographic hypoechoic region adjacent to the hepatic hilum likely represents focal fat sparing, which is a normal variant in fatty liver disease. The diffuse increased echogenicity is consistent with mild hepatic steatosis (fatty liver), which is best managed through lifestyle modifications rather than imaging follow-up.
Some key points to consider in this case include:
- The patient's ultrasound findings are consistent with benign conditions that do not require surveillance, according to the guidelines 1.
- The presence of simple hepatic cysts, even with internal septations, does not necessitate follow-up imaging unless the patient becomes symptomatic 1.
- The management of fatty liver disease, which is suggested by the diffuse increased echogenicity, should focus on lifestyle modifications such as weight loss, regular exercise, avoiding alcohol, and controlling metabolic risk factors like diabetes and hyperlipidemia.
- Clinical reassessment would be warranted if the patient develops new symptoms such as right upper quadrant pain, jaundice, or unexplained weight loss.
It's also important to note that the provided guidelines from the EASL position paper on liver involvement in patients with Fontan-type circulation 1 and the ACR appropriateness criteria for liver lesion-initial characterization 1 do not directly apply to this patient's situation, as there is no indication of Fontan-type circulation or a need for characterization of a liver lesion beyond what has already been done. Therefore, the most relevant guidance comes from the EASL clinical practice guidelines on the management of cystic liver diseases 1, which supports the decision not to recommend follow-up imaging for this patient.
From the Research
Follow-up Imaging Recommendations
- The patient's ultrasound results showed multiple cysts with internal septation and no solid component or internal vascularity, which is consistent with benign cystic lesions 2.
- The presence of diffuse increased parenchymal echogenicity related to mild cytosis and geographic hypoechoic region adjacent to the hepatic caudate lobe likely representing focal fat sparing are also noted 3.
- Given the absence of solid hepatic lesions and the characteristic features of the cysts, further imaging with contrast-enhanced ultrasound (CEUS) or other modalities like CT or MRI may not be necessary unless there are changes in the patient's symptoms or lesion characteristics 4, 5.
- However, if there are concerns about the possibility of mucinous cystic neoplasms (MCNs) or other complex cysts, CT or MRI features such as thick septations/nodularity, upstream biliary dilation, thin septations, internal hemorrhage, and perfusional change can help differentiate MCNs from simple cysts 6.
- The decision to perform follow-up imaging should be based on the patient's individual risk factors, symptoms, and lesion characteristics, as well as the clinical judgment of the healthcare provider 2, 5.