Does having liver cysts mean you are sick?

Having Liver Cysts Does Not Mean You Are Sick

Simple hepatic cysts are benign developmental anomalies that occur in up to 18% of the healthy population and do not indicate illness or disease. 1, 2 The vast majority of people with liver cysts are completely asymptomatic and will never develop any problems from them.

Understanding What Liver Cysts Are

• Liver cysts are fluid-filled sacs that arise from abnormal bile duct development during embryonic formation—they are essentially a normal anatomical variant, not a disease. 1
• Simple hepatic cysts are extremely common, affecting 5-18% of adults, with most discovered incidentally on imaging performed for unrelated reasons. 1, 2
• These cysts consist of water and electrolytes in a composition similar to bile but without bile acids or bilirubin, lined by a single layer of cells. 1

When Liver Cysts Remain Harmless

• The European Association for the Study of the Liver explicitly states that asymptomatic simple hepatic cysts require no bloodwork, no treatment, and no follow-up imaging. 3, 4
• Simple cysts typically follow an indolent course without significant changes in size over time and do not affect liver function. 3
• Only approximately 5% of people with liver cysts ever develop symptoms requiring intervention. 5

When Liver Cysts May Indicate a Problem

You should be concerned about liver cysts only in these specific situations:

Multiple Cysts (Polycystic Liver Disease)

• If you have more than 10 liver cysts, this indicates polycystic liver disease (PLD), which is a genetic condition often associated with polycystic kidney disease. 4
• PLD requires screening for kidney involvement with renal function testing (creatinine, BUN). 6
• Even with PLD, most patients remain asymptomatic, though some develop symptoms from massive liver enlargement. 1

Complex or Worrisome Features

• Cysts with septations, thick walls, nodules, debris, calcifications, or enhancement on imaging require further evaluation with MRI to rule out rare malignant lesions like mucinous cystic neoplasms. 3, 4
• These complex features occur in less than 5% of liver cysts compared to simple cysts. 1

Symptomatic Cysts

• Large cysts (typically >10 cm) can occasionally cause abdominal pain, fullness, nausea, or compression of nearby structures. 1, 7
• Complications like infection, bleeding into the cyst, or rupture are rare events despite the high prevalence of cysts in the population. 1, 5

Critical Pitfalls to Avoid

• Do not order tumor markers (CA19-9, CEA) for liver cysts—these cannot distinguish benign cysts from malignant lesions and are elevated in up to 50% of simple cysts, causing unnecessary anxiety. 3, 6
• Do not pursue treatment for asymptomatic cysts, as interventions carry risks (including 2-14% mortality for major surgeries) without benefit. 1
• Spontaneous rupture of liver cysts, while reported in case series, is extraordinarily rare given that up to 18% of the population has cysts—this does not justify preventive treatment. 1

Bottom Line

If you have been told you have a simple liver cyst on ultrasound, you are not sick, you do not need treatment, and you do not need follow-up imaging. 3, 4 This is a common incidental finding that requires no action unless you develop specific symptoms like persistent abdominal pain or fullness, in which case ultrasound should be repeated to assess for complications. 3