From the Guidelines
A 0.9cm liver cyst does not require monitoring, as simple hepatic cysts are benign lesions that typically follow an indolent course without significant changes in size over time 1. Small liver cysts under 1cm are very common, benign findings that are often discovered incidentally during imaging studies for other conditions. These simple cysts are fluid-filled sacs that rarely cause symptoms or complications at this size.
Key Points to Consider
- No treatment or follow-up is generally necessary unless the cyst has atypical features on imaging (such as internal septations, solid components, or wall thickening) or if you're experiencing symptoms like pain in the upper right abdomen.
- If you have a known history of polycystic liver disease, certain genetic conditions, or liver disease, your doctor might recommend periodic monitoring through ultrasound or other imaging techniques every 6-12 months to ensure the cyst doesn't grow significantly.
- The reason these small cysts can be safely left alone is that they represent normal variations in liver structure and rarely progress to cause problems, as supported by the European Association for the Study of the Liver (EASL) clinical practice guidelines on the management of cystic liver diseases 1.
- It is not recommended to follow asymptomatic patients because of simple hepatic cysts, according to the EASL guidelines, which have a strong recommendation and 96% consensus 1.
From the Research
Liver Cyst Monitoring
- A 0.9cm liver cyst is generally considered small, and the decision to monitor it depends on various factors, including the patient's symptoms, medical history, and the characteristics of the cyst 2, 3.
- Simple liver cysts, which are typically congenital and benign, may not require monitoring unless they are causing symptoms or are at risk of rupture 3, 4.
- Complex liver cysts, which may be malignant or premalignant, require closer monitoring and may need to be treated with fenestration, aspiration sclerotherapy, or surgical resection 3, 5.
- Imaging modalities such as ultrasound, computed tomography, and magnetic resonance imaging can be used to characterize and monitor liver cysts, with MRI being particularly useful for detecting intra-cystic hemorrhage and other complications 5, 4.
Factors to Consider
- The size and shape of the cyst, as well as the presence of septations, calcifications, and mural nodularity, can help determine the risk of malignancy and the need for monitoring 3, 4.
- The patient's symptoms, such as abdominal pain or discomfort, can also influence the decision to monitor the cyst 2, 3.
- The presence of other medical conditions, such as polycystic liver disease, can increase the risk of complications and require closer monitoring 3, 4.
Imaging Modalities
- Ultrasound is often the first-line imaging modality for liver cysts, but may not provide sufficient detail for complex cysts or those with suspicious features 3, 4.
- Computed tomography and magnetic resonance imaging can provide more detailed information about the cyst and its surroundings, and can help guide treatment decisions 5, 4.
- Contrast-enhanced ultrasound and other advanced imaging modalities may also be used to characterize and monitor liver cysts 3, 6.