Having Liver Cysts Does Not Mean You Are Sick
No, having liver cysts does not mean you are sick—the vast majority of liver cysts are simple, benign lesions that remain asymptomatic throughout life and require no treatment or follow-up. 1
Understanding Simple Hepatic Cysts
Simple hepatic cysts are extremely common benign developmental anomalies:
- Prevalence is 15-18% in the general population, meaning nearly 1 in 5 people have them without any health consequences 2
- They are benign lesions that typically follow an indolent course without significant changes in size over time 1
- No bloodwork is required for asymptomatic simple hepatic cysts, as these are benign developmental anomalies 3
- No follow-up imaging is recommended for asymptomatic simple hepatic cysts, regardless of size 1, 4
When Liver Cysts Might Indicate a Problem
The key distinction is between simple cysts (benign, no concern) and other cystic liver lesions:
Simple Cysts Become Symptomatic (Rare)
- Growth and compression can cause abdominal discomfort, pain, distension, nausea, vomiting, or early satiety 5
- Complications are exceptional and include infection, spontaneous hemorrhage, or rupture 5, 6
- If symptoms develop, ultrasound should be performed first to assess cyst size and look for complications 1
Polycystic Liver Disease (PLD)
- Most patients with PLD remain asymptomatic and do not require imaging follow-up 1
- Liver cysts in PLD do not usually impact liver synthetic or secretory function, even in advanced disease 1
- Symptoms only occur when massive enlargement causes mass effect on surrounding structures 1
- Diagnosis requires >10 hepatic cysts on imaging, and renal function testing is mandatory to evaluate for concurrent autosomal dominant polycystic kidney disease 3
Worrisome Features Suggesting Malignant Potential
Certain imaging features warrant further evaluation with MRI to exclude mucinous cystic neoplasms:
- Thick septations or nodularity (major worrisome features) 1
- Thin septations, internal hemorrhage, upstream biliary dilatation, or <3 coexistent hepatic cysts (minor worrisome features) 1
- The combination of thick septations/nodularity plus at least one additional feature carries 94-98% specificity for mucinous cystic neoplasms 1
Common Pitfalls to Avoid
Radiologic overdiagnosis is a significant problem: A 2023 study found that radiologists frequently report "rule out biliary cystadenoma" for simple hepatic cysts, leading to unnecessary anxiety and surgery in asymptomatic patients—yet 95% of these cases were confirmed as simple benign cysts on pathology 7. This highlights that:
- Tumor markers (CEA and CA19-9) cannot reliably differentiate between simple hepatic cysts and mucinous cystic neoplasms 1, 8, 3
- Most cysts reported as "concerning" on imaging are ultimately benign 7
- Asymptomatic cysts do not require treatment, even if large 1, 4
Bottom Line
Having liver cysts discovered incidentally on imaging is a normal finding in up to 18% of the population and does not indicate illness. 2 The overwhelming majority are simple hepatic cysts that require no treatment, no follow-up, and no bloodwork. 1, 3 You are only "sick" if the cysts cause symptoms (rare), if you have polycystic liver disease with massive hepatomegaly causing mass effect (uncommon), or if imaging shows worrisome features suggesting a rare malignant or premalignant lesion (very rare). 1