What is a Septated Cyst and How is it Treated?
A septated cyst is a fluid-filled sac with internal dividing walls (septations) that can occur in various organs, most commonly in the liver or ovaries, and treatment depends on the cyst's location, size, and risk of malignancy, with options ranging from observation to surgical removal. 1
Understanding Septated Cysts
What is a septated cyst?
A septated cyst contains internal dividing walls or partitions that create multiple compartments within the cyst. These septations appear as thin lines crossing through the fluid-filled space when viewed on imaging studies like ultrasound, CT scans, or MRI.
Types of septated cysts:
- Simple septated cysts: Have thin, regular septations
- Complex septated cysts: Have thicker septations, irregular walls, or solid components
Common locations:
- Liver
- Ovaries
- Pancreas
- Kidneys
Diagnosis of Septated Cysts
Imaging techniques:
- Ultrasound: Usually the first imaging test; shows the cyst's structure, septations, and whether it's solid or fluid-filled 1
- MRI: Best for detailed characterization of cyst contents and septations; can detect hemorrhage within cysts 1
- CT scan: Good for detecting calcifications but less accurate for assessing cyst contents 1
Concerning features that may suggest higher risk:
Major worrisome features 1:
- Thick septations
- Nodularity (small growths within the cyst)
Minor worrisome features 1:
- Thin septations
- Internal hemorrhage
- Fewer than 3 coexistent cysts (in liver)
Treatment Approaches
1. Observation (watchful waiting)
Appropriate for:
- Simple septated cysts without worrisome features
- Asymptomatic small cysts
- Cysts with typical benign features
Follow-up recommendations:
- Regular imaging (ultrasound or MRI) every 6-12 months to monitor for changes in size or appearance 1
2. Percutaneous aspiration with or without sclerotherapy
Appropriate for:
- Symptomatic simple septated cysts
- Larger cysts causing discomfort
Note: This should be avoided during active hemorrhage within a cyst 1
3. Surgical removal
Indicated for:
- Cysts with worrisome features suggesting possible malignancy
- Symptomatic cysts not responding to less invasive treatments
- Mucinous cystic neoplasms (MCNs) 1
Surgical options include:
- Laparoscopic deroofing: For accessible benign cysts
- Complete surgical resection: For suspected mucinous cystic neoplasms or when malignancy cannot be ruled out 1
Special Considerations
Hemorrhagic septated cysts
- Often occur spontaneously in larger cysts (>8 cm)
- Present with sudden, severe pain
- Conservative management is preferred during active bleeding 1
- If on blood thinners:
- Anticoagulants should be restarted 7-15 days after hemorrhage
- Aspirin should be interrupted for 3 days following hemorrhage 1
Mucinous cystic neoplasms (MCNs)
These are special types of septated cysts that require complete surgical removal due to malignancy risk 1
When to Seek Medical Attention
Seek medical care if you experience:
- Sudden, severe pain (may indicate cyst hemorrhage or rupture)
- Increasing abdominal discomfort or fullness
- Growth of a known cyst
- Development of new symptoms with a previously diagnosed cyst
Key Takeaways
Most simple septated cysts are benign and can be monitored with regular imaging.
MRI is the preferred imaging method for detailed characterization of septated cysts 1.
The presence of thick septations, nodularity, or other worrisome features increases the risk of the cyst being a mucinous cystic neoplasm, which may require surgical removal 1.
Treatment decisions should be based on the cyst's location, size, appearance on imaging, and whether it's causing symptoms.