Can People Have Liver Cysts Without Knowing It?
Yes, most people with liver cysts are completely unaware they have them, as these lesions are typically asymptomatic and discovered incidentally on imaging performed for other reasons. 1
Prevalence and Natural History
- Liver cysts are remarkably common in the general population, occurring in 15-18% of adults in the United States. 1, 2
- Simple hepatic cysts are benign lesions that typically follow an indolent course without significant changes in size over time. 1, 3
- Most patients with polycystic liver disease (PLD) are, and will remain, asymptomatic throughout their lives. 1
Why They Go Unnoticed
- Simple hepatic cysts cause no symptoms in the vast majority of cases and are not associated with altered hepatic function. 4
- These cysts are usually discovered incidentally during abdominal imaging (ultrasound, CT, or MRI) performed for unrelated medical reasons. 1, 2, 5
- The high prevalence of asymptomatic cysts (up to 18% of the population) combined with the low rate of symptomatic complications demonstrates that most people harbor these lesions unknowingly. 3
When Cysts Become Symptomatic
Only a minority of patients develop symptoms, which typically occur when:
- Cysts grow large enough to cause mass effect, resulting in abdominal pain, back pain, early satiety, dyspnea, or malnutrition. 1
- Complications develop, including intracystic hemorrhage (which usually resolves spontaneously), infection (requiring active management), or rarely, rupture. 1, 4
- Biliary compression occurs from centrally located cysts, causing peripheral bile duct dilatation with elevated alkaline phosphatase or jaundice. 6
Clinical Management Implications
- No follow-up imaging is recommended for asymptomatic simple hepatic cysts, regardless of size. 1, 3
- Ultrasound should be the first diagnostic modality if symptoms develop. 1, 3
- Treatment is only indicated when quality of life is altered or complications occur, not based on cyst size alone. 1, 3
- Treatment success is defined by symptom relief, not by volume reduction of hepatic cysts. 3, 6
Important Caveats
- While simple cysts are benign, hepatic cysts demonstrating complex features (atypical cyst wall, septations, mural nodularity, debris) require further evaluation with MRI or CT to exclude mucinous cystic neoplasms or other malignancies. 1, 2
- Tumor markers (CEA and CA19-9) cannot reliably differentiate between simple cysts and neoplasms, so imaging characteristics remain the primary diagnostic tool. 1, 3
- Avoid the common pitfall of over-diagnosing "rule out biliary cystadenoma" on radiology reports, which leads to unnecessary anxiety and surgery in patients with simple cysts. 7