From the Guidelines
Multiple small hepatic cysts, largest 2 cm in size, are unlikely to cause right upper quadrant (RUQ) pain. According to the EASL clinical practice guidelines on the management of cystic liver diseases 1, simple hepatic cysts are benign lesions that typically follow an indolent course without significant changes in size over time. The guidelines suggest that there is no indication for follow-up of simple hepatic cysts, whatever the size, and that symptomatic hepatic cysts can be treated surgically or with percutaneous aspiration sclerotherapy.
Key Points to Consider
- Most hepatic cysts are asymptomatic and are discovered incidentally during imaging studies performed for other reasons.
- Pain usually only occurs when cysts become very large (generally greater than 4-5 cm), become infected, bleed, rupture, or compress surrounding structures.
- If a patient with small hepatic cysts is experiencing RUQ pain, other causes should be investigated, such as gallbladder disease, hepatitis, or other liver conditions.
- The liver capsule has limited pain receptors, and small cysts don't typically stretch the liver capsule enough to trigger pain signals.
Diagnostic Approach
- Imaging (ultrasound first) will assess the size and look for complications and compression if patients become symptomatic.
- If the cysts are determined to be the source of pain (which would be unusual for 2 cm cysts), treatment options might include percutaneous aspiration with sclerotherapy or surgical deroofing for persistent symptoms.
From the Research
Hepatic Cysts and RUQ Pain
- Multiple small hepatic cysts, largest 2 cm in size, can cause right upper quadrant (RUQ) pain due to growth and compression of the cysts 2.
- The compression of hepatic cysts can lead to abdominal discomfort, pain, distension, and dietary symptoms such as nausea, vomiting, a feeling of fullness, and early satiety 2.
- Asymptomatic simple hepatic cysts do not require treatment, but symptomatic cysts may require treatment, including percutaneous aspiration, aspiration followed by sclerotherapy, and surgery 2, 3, 4.
Diagnosis and Treatment
- Imaging modalities such as ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI) can be used to diagnose and characterize hepatic cysts 2, 3, 4.
- The treatment of hepatic cysts depends on the size, location, and symptoms of the cyst, as well as the patient's overall health 5, 6.
- Laparoscopic fenestration is a recommended treatment for symptomatic simple hepatic cysts due to its high success rate and low invasiveness 2, 6.
Cyst Size and Symptoms
- A study found that cysts larger than 2 cm were more likely to cause symptoms, including abdominal discomfort and pain 5.
- Another study found that the median cyst size for symptomatic cases was 13.7 cm, while the median cyst size for asymptomatic cases was 2.1 cm 5.
- However, even small cysts, largest 2 cm in size, can cause RUQ pain if they are compressing surrounding tissues or causing other complications 2, 5.