From the Guidelines
Multiple small hepatic cysts, with the largest measuring 2 cm in size, do not require any follow-up, as long as they are simple cysts. According to the most recent guidelines, simple hepatic cysts are benign lesions that typically follow an indolent course without significant changes in size over time 1. The European Association for the Study of the Liver (EASL) clinical practice guidelines on the management of cystic liver diseases, published in 2022, state that there is no indication for follow-up of simple hepatic cysts, regardless of their size 1.
Key points to consider in the management of simple hepatic cysts include:
- They are common, benign findings that are often discovered incidentally during imaging studies
- Routine surveillance is generally unnecessary unless the patient develops symptoms such as pain in the right upper quadrant, early satiety, or nausea
- If patients become symptomatic, imaging (ultrasound first) will assess the size and look for complications and compression 1
- Symptomatic hepatic cysts can be treated surgically or with percutaneous aspiration sclerotherapy
It is essential to note that the presence of atypical features on imaging, such as septations, mural nodules, wall thickening, or calcifications, may warrant follow-up imaging in 6-12 months with ultrasound or MRI to ensure stability. However, for simple hepatic cysts without any concerning features, no follow-up is necessary, as stated in the EASL guidelines 1.
From the Research
Hepatic Cysts Overview
- Hepatic cysts are frequently discovered incidentally on abdominal imaging, with a prevalence of 15-18% in the United States 2.
- Most cysts are benign, but some are malignant or premalignant, making diagnosis and management crucial 2.
Diagnosis and Management
- Imaging modalities such as ultrasound, computed tomography, magnetic resonance imaging, or contrast-enhanced ultrasound can be used to characterize and diagnose hepatic cysts 2.
- Treatment is indicated in symptomatic cysts or those suspicious for malignant or premalignant features, with modalities including fenestration, aspiration sclerotherapy, or surgical resection 2, 3, 4.
- Simple cysts are mainly congenital cysts, but also occur in polycystic liver disease, while complex cysts include mucinous neoplasms, echinococcal cysts, hemorrhagic cysts, cystic hepatocellular carcinoma, and other rare lesions 2.
Follow-up for Small Hepatic Cysts
- For small hepatic cysts, largest 2 cm in size, conservative management is practical, and surgical excision is recommended in patients with larger cysts, causing pressure symptoms, or if the cyst size does not seem to involute with intractable abdominal pain or becomes complicated in the follow-up period 5.
- Asymptomatic patients with small cysts can be observed, with a low risk of complications or enlargement 5.
- The size of the cyst is an important factor in determining the need for follow-up or intervention, with larger cysts being more likely to cause symptoms or complications 3, 4, 5.