From the Guidelines
Hepatic cysts often cause no symptoms, but when symptoms do occur, patients may experience abdominal pain, abdominal fullness, bloating, and early satiety, as well as complications such as cyst rupture, infection, or hemorrhaging, as noted in the EASL clinical practice guidelines on the management of cystic liver diseases 1.
Symptoms and Complications
The symptoms of hepatic cysts can vary depending on the size and location of the cyst within the liver. Some common symptoms include:
- Abdominal pain or discomfort in the upper right quadrant
- Abdominal fullness or bloating
- Early satiety
- Palpable mass in the upper abdomen
- Cyst rupture, which may cause sudden, severe abdominal pain and potentially peritonitis
- Infected cysts, which may lead to fever, chills, and worsening abdominal pain
- Rarely, very large cysts can cause jaundice by compressing the bile ducts, as discussed in the guidelines 1.
Diagnosis and Treatment
The diagnosis of hepatic cysts typically involves imaging studies, such as ultrasound, CT, or MRI, as recommended in the guidelines 1. Treatment options for symptomatic hepatic cysts include percutaneous aspiration sclerotherapy, cyst fenestration, or surgical removal, with the goal of reducing the cyst's volume and alleviating symptoms, as noted in the guidelines 1.
Key Considerations
It is essential to note that asymptomatic patients with simple hepatic cysts do not require follow-up, as stated in the guidelines 1. However, symptomatic patients should be treated with the best locally available volume-reducing therapy, as recommended in the guidelines 1. Additionally, hepatic cyst infection should be considered in the presence of neutrophil debris and/or microorganisms in cyst aspirate, as noted in the guidelines 1.
From the Research
Symptoms of Hepatic Cyst
- Abdominal discomfort or pain, particularly in the right upper quadrant 2
- Nausea and vomiting 2
- Feeling of fullness or early satiety 2
- Diarrhea 3
- Fever 3, 4, 5
- Abdominal distension 2
Complications of Hepatic Cyst
- Infection 3, 4, 5
- Spontaneous hemorrhage 2
- Rupture 2
- External compression of the biliary tree or major vessels 2
Diagnostic Findings
- Ultrasonography may show a hypoechoic lesion or anechoic cysts 3, 2, 5
- Computed tomography (CT) may reveal multiple hepatic cysts, including an infected cyst with a thickened wall enhanced with contrast media 3
- Magnetic resonance imaging (MRI) can be used to characterize cystic hepatic lesions 6
- Elevated serum concentration of C-reactive protein, white blood cell count, CA19-9, and CEA may be present 3