Can Liver Cysts Resolve on Their Own?
Simple hepatic cysts typically do not resolve spontaneously and follow an indolent course without significant changes in size over time, with the notable exception that intracystic hemorrhage within a hepatic cyst resolves spontaneously without requiring treatment. 1
Natural History of Simple Hepatic Cysts
Simple hepatic cysts are benign developmental anomalies that remain stable in most cases. 1 The European Association for the Study of the Liver guidelines clearly state that these lesions "typically follow an indolent course without significant changes in size over time." 1 While some cysts may grow, it remains unclear why certain simple cysts enlarge while others remain stable. 1
The One Exception: Hemorrhagic Cysts
Intracystic hemorrhage is the only complication of simple hepatic cysts that resolves spontaneously and does not require treatment. 1, 2 This is an important clinical distinction—if a cyst bleeds into itself, the hemorrhage will resolve on its own without intervention. 1, 2
Clinical Implications for Management
Given that simple hepatic cysts do not spontaneously disappear, the following management approach is recommended:
For Asymptomatic Cysts
- No follow-up imaging is indicated for asymptomatic simple hepatic cysts, regardless of size. 1, 3 This represents a strong recommendation with 96% consensus from the European Association for the Study of the Liver. 1, 3
- No bloodwork is required for asymptomatic simple hepatic cysts. 3
For Symptomatic Cysts
- If symptoms develop, ultrasound should be the first diagnostic modality used to assess size and look for complications or compression. 1, 3
- Symptomatic cysts require volume-reducing therapy (surgical fenestration or percutaneous aspiration sclerotherapy), as they will not resolve on their own. 1, 3, 2
- Treatment success is defined by symptom relief, not by volume reduction of the cysts. 1, 3, 2
Post-Treatment Expectations
- Routine follow-up imaging after treatment is not recommended (92% consensus), as the goal is symptom relief rather than cyst disappearance. 1, 3
Common Pitfalls to Avoid
Do not wait for simple hepatic cysts to resolve spontaneously if they are causing symptoms. 1 These lesions are stable developmental anomalies that will not disappear without intervention. 1 The only scenario where spontaneous resolution occurs is with intracystic hemorrhage, which is a rare complication. 1, 2
Do not perform serial imaging hoping to document cyst resolution in asymptomatic patients. 1, 3 This practice is not recommended and provides no clinical benefit, as these cysts remain stable over time and do not require monitoring. 1, 3