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Kahraman G, Haberal KM, Dilek ON. Imaging features and management of focal liver lesions. World J Radiol 2024; 16:139-167. [PMID: 38983841 PMCID: PMC11229941 DOI: 10.4329/wjr.v16.i6.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/28/2024] [Accepted: 05/22/2024] [Indexed: 06/26/2024] Open
Abstract
Notably, the number of incidentally detected focal liver lesions (FLLs) has increased dramatically in recent years due to the increased use of radiological imaging. The diagnosis of FLLs can be made through a well-documented medical history, physical examination, laboratory tests, and appropriate imaging methods. Although benign FLLs are more common than malignant ones in adults, even in patients with primary malignancy, accurate diagnosis of incidental FLLs is of utmost clinical significance. In clinical practice, FLLs are frequently evaluated non-invasively using ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI). Although US is a cost-effective and widely used imaging method, its diagnostic specificity and sensitivity for FLL characterization are limited. FLLs are primarily characterized by obtaining enhancement patterns through dynamic contrast-enhanced CT and MRI. MRI is a problem-solving method with high specificity and sensitivity, commonly used for the evaluation of FLLs that cannot be characterized by US or CT. Recent technical advancements in MRI, along with the use of hepatobiliary-specific MRI contrast agents, have significantly improved the success of FLL characterization and reduced unnecessary biopsies. The American College of Radiology (ACR) appropriateness criteria are evidence-based recommendations intended to assist clinicians in selecting the optimal imaging or treatment option for their patients. ACR Appropriateness Criteria Liver Lesion-Initial Characterization guideline provides recommendations for the imaging methods that should be used for the characterization of incidentally detected FLLs in various clinical scenarios. The American College of Gastroenterology (ACG) Clinical Guideline offers evidence-based recommendations for both the diagnosis and management of FLL. American Association for the Study of Liver Diseases (AASLD) Practice Guidance provides an approach to the diagnosis and management of patients with hepatocellular carcinoma. In this article, FLLs are reviewed with a comprehensive analysis of ACR Appropriateness Criteria, ACG Clinical Guideline, AASLD Practice Guidance, and current medical literature from peer-reviewed journals. The article includes a discussion of imaging methods used for the assessment of FLL, current recommended imaging techniques, innovations in liver imaging, contrast agents, imaging features of common nonmetastatic benign and malignant FLL, as well as current management recommendations.
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Affiliation(s)
- Gökhan Kahraman
- Department of Radiology, Suluova State Hospital, Amasya 05500, Türkiye
| | - Kemal Murat Haberal
- Department of Radiology, Başkent University Faculty of Medicine, Ankara 06490, Türkiye
| | - Osman Nuri Dilek
- Department of Surgery, İzmir Katip Celebi University, School of Medicine, İzmir 35150, Türkiye
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2
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Drenth J, Barten T, Hartog H, Nevens F, Taubert R, Torra Balcells R, Vilgrain V, Böttler T. EASL Clinical Practice Guidelines on the management of cystic liver diseases. J Hepatol 2022; 77:1083-1108. [PMID: 35728731 DOI: 10.1016/j.jhep.2022.06.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 06/01/2022] [Indexed: 02/07/2023]
Abstract
The advent of enhanced radiological imaging techniques has facilitated the diagnosis of cystic liver lesions. Concomitantly, the evidence base supporting the management of these diseases has matured over the last decades. As a result, comprehensive clinical guidance on the subject matter is warranted. These Clinical Practice Guidelines cover the diagnosis and management of hepatic cysts, mucinous cystic neoplasms of the liver, biliary hamartomas, polycystic liver disease, Caroli disease, Caroli syndrome, biliary hamartomas and peribiliary cysts. On the basis of in-depth review of the relevant literature we provide recommendations to navigate clinical dilemmas followed by supporting text. The recommendations are graded according to the Oxford Centre for Evidence-Based Medicine system and categorised as 'weak' or 'strong'. We aim to provide the best available evidence to aid the clinical decision-making process in the management of patients with cystic liver disease.
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Norcia LF, Watanabe EM, Hamamoto Filho PT, Hasimoto CN, Pelafsky L, de Oliveira WK, Sassaki LY. Polycystic Liver Disease: Pathophysiology, Diagnosis and Treatment. Hepat Med 2022; 14:135-161. [PMID: 36200122 PMCID: PMC9528914 DOI: 10.2147/hmer.s377530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 09/07/2022] [Indexed: 11/25/2022] Open
Abstract
Polycystic liver disease (PLD) is a clinical condition characterized by the presence of more than 10 cysts in the liver. It is a rare disease Of genetic etiology that presents as an isolated disease or assoc\iated with polycystic kidney disease. Ductal plate malformation, ciliary dysfunction, and changes in cell signaling are the main factors involved in its pathogenesis. Most patients with PLD are asymptomatic, but in 2–5% of cases the disease has disabling symptoms and a significant reduction in quality of life. The diagnosis is based on family history of hepatic and/or renal polycystic disease, clinical manifestations, patient age, and polycystic liver phenotype shown on imaging examinations. PLD treatment has evolved considerably in the last decades. Somatostatin analogues hold promise in controlling disease progression, but liver transplantation remains a unique curative treatment modality.
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Affiliation(s)
- Luiz Fernando Norcia
- Department of Surgery, São Paulo State University (Unesp), Medical School, Botucatu, São Paulo, Brazil
- Correspondence: Luiz Fernando Norcia, Department of Surgery, São Paulo State University (UNESP), Medical School, 783 Pedro Delmanto Street, Botucatu, São Paulo, 18610-303, Brazil, Tel +55 19982840542, Email
| | - Erika Mayumi Watanabe
- Department of Radiology, São Paulo State University (Unesp), Medical School, Botucatu, São Paulo, Brazil
| | - Pedro Tadao Hamamoto Filho
- Department of Neurology, Psychology and Psychiatry, São Paulo State University (Unesp), Medical School, Botucatu, São Paulo, Brazil
| | - Claudia Nishida Hasimoto
- Department of Surgery, São Paulo State University (Unesp), Medical School, Botucatu, São Paulo, Brazil
| | - Leonardo Pelafsky
- Department of Surgery, São Paulo State University (Unesp), Medical School, Botucatu, São Paulo, Brazil
| | - Walmar Kerche de Oliveira
- Department of Surgery, São Paulo State University (Unesp), Medical School, Botucatu, São Paulo, Brazil
| | - Ligia Yukie Sassaki
- Department of Internal Medicine, São Paulo State University (Unesp), Medical School, Botucatu, São Paulo, Brazil
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4
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The prevalence and natural history of hepatic cysts examined by ultrasound: a health checkup population retrospective cohort study. Sci Rep 2022; 12:12797. [PMID: 35896780 PMCID: PMC9329350 DOI: 10.1038/s41598-022-16875-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 07/18/2022] [Indexed: 01/14/2023] Open
Abstract
The prevalence of hepatic cysts in the general population and their natural history are largely unknown. This study aimed to assess the prevalence and natural history of hepatic cysts by investigating health checkup participants. Ultrasonographic data of health checkup participants (n = 38,842) were retrospectively evaluated to calculate its prevalence. In addition, we assessed the changes in the size and characteristics of hepatic cysts over 10 years (n = 7709). We found the prevalence of hepatic cysts was 21.9%. Older age, female sex, and presence of kidney cysts or pancreatic cysts were associated with the occurrence of hepatic cysts. Younger age, female sex, and the existence of multiple hepatic cysts were associated with cyst enlargement. Among 126 individuals who had hepatic cysts with a diameter of 30 mm or larger at the first visit, two (1.6%) required treatment. Remain 124 cases showed four patterns: 44 cases with enlargement, 47 stable, 11 regression after enlargement, and 22 regression. Hyperechoic fluid inside the cysts was observed in 54.5% (18 of 33), which was significantly higher than 6.6% (6 of 91) of the non-regression (OR = 17.0). The appearance of intracystic hyperechoic fluid by ultrasound may predict subsequent regression of the hepatic cyst.
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Ben Ismail I, Sghaier M, Zenaidi H, Zoghlami A. Intracystic Haemorrhage of a Simple Liver Cyst Secondary to Vitamin-K Antagonist Overdosage. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03381-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Brusic A, Oo J, Stella DL, Simkin PM, Loveday BP. Giant haemorrhagic hepatic cyst with flame-like morphology in a patient with polycystic kidney and liver disease. ULTRASOUND : JOURNAL OF THE BRITISH MEDICAL ULTRASOUND SOCIETY 2021; 29:187-192. [PMID: 34567231 DOI: 10.1177/1742271x20987263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 12/07/2020] [Indexed: 11/16/2022]
Abstract
Introduction Intracystic haemorrhage is a rare complication of hepatic cysts, and is often mistaken for a malignant lesion. Case Report A 55-year-old female with a history of polycystic kidney and liver disease presented with a six-month history of abdominal distension, abdominal pain, early satiety, shortness of breath and 5 kg of weight loss. Imaging revealed a 20 cm mixed solid-cystic hepatic lesion containing peripheral avascular mobile echogenic material with a flame-like morphology. After experiencing symptomatic relief from ultrasound-guided aspiration, the patient underwent cyst fenestration for more definitive treatment. Discussion Haemorrhagic hepatic cysts are uncommon and may present on imaging as having lace-like retractile clot, internal layering or shading of separating blood products or avascular mobile flame-like excrescences. The presence of avascular mobile flame-like excrescences appears to be a unique feature of haemorrhagic hepatic cysts. Conclusion While haemorrhagic hepatic cysts are rare and commonly mistaken for biliary cystadenomas or adenocarcinomas, the identification of particular features on high-resolution magnetic resonance imaging and contrast-enhanced ultrasound can lead to the correct diagnosis.
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Affiliation(s)
- Ana Brusic
- Department of Radiology, Royal Melbourne Hospital, Parkville, Australia
| | - June Oo
- Surgical Oncology, Peter MacCallum Cancer Centre, Parkville, Australia
| | - Damien L Stella
- Department of Radiology, Royal Melbourne Hospital, Parkville, Australia.,Department of Radiology, University of Melbourne, Parkville, Australia
| | - Paul M Simkin
- Department of Radiology, Royal Melbourne Hospital, Parkville, Australia.,Department of Radiology, University of Melbourne, Parkville, Australia
| | - Benjamin Pt Loveday
- Surgical Oncology, Peter MacCallum Cancer Centre, Parkville, Australia.,Department of Surgery, Royal Melbourne Hospital, Parkville, Australia.,Department of Surgery, University of Auckland, Auckland, New Zealand
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Shimizu T, Yoshioka M, Kaneya Y, Kanda T, Aoki Y, Kondo R, Takata H, Ueda J, Kawano Y, Hirakata A, Matsushita A, Taniai N, Mamada Y, Yoshida H. Management of simple hepatic cyst. J NIPPON MED SCH 2021; 89:2-8. [PMID: 34526451 DOI: 10.1272/jnms.jnms.2022_89-115] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Simple hepatic cysts are typically saccular, thin-walled masses with fluid-filled epithelial lined cavities that arise from aberrant bile duct cells during embryonic development. With the development of diagnostic modalities such as ultrasonography, computed tomography and magnetic resonance imaging, simple hepatic cysts are seen with relative frequency in daily clinical examination. US is the most useful and noninvasive tool for the diagnosis of simple hepatic cysts, and can generally differentiate simple hepatic cysts from abscesses, hemangiomas and malignancies. Cysts with irregular walls, septations, calcifications or daughter cysts on US should be evaluated with enhanced CT or MRI to differentiate simple hepatic cysts from cystic neoplasms or hydatid cysts.Growth and compression of hepatic cysts cause abdominal discomfort, pain, distension and dietary symptoms such as nausea, vomiting, a feeling of fullness and early satiety. Complications of simple hepatic cysts include infection, spontaneous hemorrhage, rupture, and external compression of biliary tree or major vessels.Asymptomatic simple hepatic cysts should be observed. Treatment for symptomatic simple hepatic cysts includes percutaneous aspiration, aspiration followed by sclerotherapy, and surgery. The American College of Gastroenterology clinical guidelines recommend laparoscopic fenestration based on its high success rate and low invasiveness. Percutaneous procedures for treatment of simple hepatic cysts are particularly effective for the immediate palliation of patient symptoms; however, they are not generally recommended because of the high rate of recurrence.Management of simple hepatic cysts requires correct differentiation from neoplasms and infections, and the selection of a reliable treatment.
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Affiliation(s)
- Tetsuya Shimizu
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School
| | - Masato Yoshioka
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School
| | - Yohei Kaneya
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School
| | - Tomohiro Kanda
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School
| | - Yuto Aoki
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School
| | - Ryota Kondo
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School
| | - Hideyuki Takata
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School
| | - Junji Ueda
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School
| | - Youichi Kawano
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School
| | - Atsushi Hirakata
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School
| | - Akira Matsushita
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School
| | - Nobuhiko Taniai
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School
| | - Yasuhiro Mamada
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School
| | - Hiroshi Yoshida
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School
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Abstract
Androgens are potent drugs requiring prescription for valid medical indications but are misused for invalid, unproven, or off-label reasons as well as being abused without prescription for illicit nonmedical application for performance or image enhancement. Following discovery and first clinical application of testosterone in the 1930s, commercialization of testosterone and synthetic androgens proliferated in the decades after World War II. It remains among the oldest marketed drugs in therapeutic use, yet after 8 decades of clinical use, the sole unequivocal indication for testosterone remains in replacement therapy for pathological hypogonadism, organic disorders of the male reproductive system. Nevertheless, wider claims assert unproven, unsafe, or implausible benefits for testosterone, mostly representing wishful thinking about rejuvenation. Over recent decades, this created an epidemic of testosterone misuse involving prescription as a revitalizing tonic for anti-aging, sexual dysfunction and/or obesity, where efficacy and safety remains unproven and doubtful. Androgen abuse originated during the Cold War as an epidemic of androgen doping among elite athletes for performance enhancement before the 1980s when it crossed over into the general community to become an endemic variant of drug abuse in sufficiently affluent communities that support an illicit drug industry geared to bodybuilding and aiming to create a hypermasculine body physique and image. This review focuses on the misuse of testosterone, defined as prescribing without valid clinical indications, and abuse of testosterone or synthetic androgens (androgen abuse), defined as the illicit use of androgens without prescription or valid indications, typically by athletes, bodybuilders and others for image-oriented, cosmetic, or occupational reasons.
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Affiliation(s)
- David J Handelsman
- ANZAC Research Institute, University of Sydney, Sydney, Australia.,Andrology Department, Concord Hospital, Sydney, Australia
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Imagami T, Takayama S, Maeda Y, Sakamoto M, Kani H. Transcatheter arterial embolization for hemorrhagic rupture of a simple hepatic cyst: A case report. Radiol Case Rep 2021; 16:1956-1960. [PMID: 34149982 PMCID: PMC8193074 DOI: 10.1016/j.radcr.2021.04.066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 12/14/2022] Open
Abstract
Hemorrhagic rupture is a very rare and life-threatening hepatic cyst complication. Several treatment methods have been used for hepatic cyst hemorrhage and/or rupture; however, transcatheter arterial embolization for hepatic cyst hemorrhage has been poorly documented. An 80-year-old man receiving dual antiplatelet therapy was diagnosed with hemorrhagic rupture of a hepatic cyst. Transcatheter arterial embolization using a coil was performed for A6 branch confirmed active extravasation. His condition improved promptly after treatment, and the hepatic cyst gradually became smaller as compared to the size before hemorrhage. Transcatheter arterial embolization is suitable for hepatic cyst hemorrhage and might be a minimally invasive treatment option for a symptomatic hepatic cyst.
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Affiliation(s)
- Toru Imagami
- Department of surgery, Nagoya Tokushukai General Hospital, Kasugai City, Japan
| | - Satoru Takayama
- Department of surgery, Nagoya Tokushukai General Hospital, Kasugai City, Japan
| | - Yohei Maeda
- Department of surgery, Nagoya Tokushukai General Hospital, Kasugai City, Japan
| | - Masaki Sakamoto
- Department of surgery, Nagoya Tokushukai General Hospital, Kasugai City, Japan
| | - Hisanori Kani
- Department of surgery, Nagoya Tokushukai General Hospital, Kasugai City, Japan
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10
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Mikami K, Yukimoto H. Delayed Intracystic Hemorrhage after Percutaneous Drainage and Sclerotherapy for a Symptomatic Giant Hepatic Cyst: A Case Report. INTERVENTIONAL RADIOLOGY 2021; 6:61-64. [PMID: 35909912 PMCID: PMC9327434 DOI: 10.22575/interventionalradiology.2021-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 03/28/2021] [Indexed: 11/15/2022]
Abstract
Herein, we have reported a rare case of intracystic hemorrhage due to rupture of a right hepatic artery pseudoaneurysm in a 76-year-old female patient who underwent drainage and 3% polidocanol sclerotherapy for a symptomatic giant hepatic cyst. One month after sclerotherapy, the patient presented to the emergency room with acute and severe abdominal pain. Non-contrast T1-weighted magnetic resonance imaging findings showed high hepatic cyst fluid signal intensity and abdominal arteriography findings revealed a right hepatic artery pseudoaneurysm surrounding the hepatic cystic wall. Therefore, the patient was diagnosed with intracystic hemorrhage due to a ruptured pseudoaneurysm. Embolization, using a detachable coil, was successful. Interventional radiologists should be aware of potential vascular injuries during drainage and sclerotherapy for giant hepatic cysts.
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Affiliation(s)
- Koji Mikami
- Department of Diagnostic & Interventional Radiology, Kansai Rosai Hospital
| | - Hiroshi Yukimoto
- Department of Diagnostic & Interventional Radiology, Kansai Rosai Hospital
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Affiliation(s)
- Yannis Reissis
- Department of Surgical Oncology Johns Hopkins Hospital Baltimore, Maryland
| | - Richard Burkhart
- Department of Surgical Oncology Johns Hopkins Hospital Baltimore, Maryland
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12
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Tong KS, Hassan R, Gan J, Warsi A. Simple hepatic cyst rupture exacerbated by anticoagulation. BMJ Case Rep 2019; 12:12/9/e230243. [PMID: 31527205 DOI: 10.1136/bcr-2019-230243] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Simple hepatic cysts are usually asymptomatic but can rarely result in life-threatening complications such as haemoperitoneum secondary to rupture. A 70-year-old woman with known simple hepatic cyst presented with acute chest pain and dyspnoea. The initial diagnosis was pulmonary embolism, and anticoagulation was commenced. However, she subsequently collapsed with haemodynamic instability. CT revealed a large hepatic cyst haematoma with rupture into the peritoneal cavity. The patient underwent emergency laparotomy, haemostasis and partial deroofing of the cyst. Retrospective review of CT scans suggested that the bleed had begun on presentation but was exacerbated by anticoagulation. To our knowledge, this is the first report of haemorrhagic hepatic cyst associated with acute anticoagulation. We discuss several important clinical lessons including cyst rupture as a possible cause of chest pain, the need for careful review of imaging and the choice of anticoagulation in patients with known simple hepatic cyst.
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Affiliation(s)
- Kin Seng Tong
- General Surgery, Furness General Hospital, Barrow-in-Furness, Cumbria, UK
| | - Ridwanul Hassan
- General Surgery, Furness General Hospital, Barrow-in-Furness, Cumbria, UK
| | - Jonathan Gan
- General Surgery, Furness General Hospital, Barrow-in-Furness, Cumbria, UK
| | - Ali Warsi
- General Surgery, Furness General Hospital, Barrow-in-Furness, Cumbria, UK
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Tran Cao HS, Marcal LP, Mason MC, Yedururi S, Joechle K, Wei SH, Vauthey JN. Benign hepatic incidentalomas. Curr Probl Surg 2019; 56:100642. [DOI: 10.1067/j.cpsurg.2019.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 05/09/2019] [Indexed: 12/13/2022]
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Intracystic Hemorrhage Complicating Polycystic Liver Disease in a 90-Year-Old Woman. ACG Case Rep J 2019; 6:e00049. [PMID: 31616733 PMCID: PMC6658037 DOI: 10.14309/crj.0000000000000049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 01/11/2019] [Indexed: 11/17/2022] Open
Abstract
Nonparasitic hepatic cysts are common benign tumors that are often asymptomatic and incidentally discovered on imaging. Intracystic hemorrhage is a rare complication of hepatic cysts. We review the literature and discuss a case of intracystic hemorrhage in a 90-year-old woman with polycystic liver disease. The patient underwent cyst aspiration and percutaneous drain placement with subsequent resolution of symptoms. To our knowledge, we report the oldest patient to present with hemorrhage into a hepatic cyst. This case presents unique challenges in management, both because of the patient's age and because of her polycystic liver disease.
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15
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Abstract
Objective An infectious hepatic cyst (IHC) is a hepatic cyst complicated with secondary infection and is generally assumed to be rare. However, we have experienced no small number of patients with IHC in recent clinical practice. We therefore examined the incidence and clinical characteristics of IHC. Methods The medical records of patients with IHC who were hospitalized at our institution between January 2012 and December 2016 were retrospectively reviewed. Their demographic factors, biochemical, bacteriological, imaging, and treatment results were explored and compared with those of patients with pyogenic liver abscess (PLA). Patients Twelve patients with IHC and 39 with PLA were identified. Results The IHCs were significantly larger in diameters than the PLAs, and patients with IHCs tended to be older and more often women than those with PLAs. IHCs showed characteristic imaging features, including heterogeneous contents with occasional fluid-debris levels, a thickened cystic wall with rim enhancement, perilesional edema and hyperaemia. Patients with IHCs had a significantly shorter hospital stay than those with PLAs. Conclusion Physicians should note that IHCs are not rare. A careful imaging evaluation can suggest an IHC, and the timely aspiration of the content can lead to an accurate diagnosis. The cystic wall may keep the infectious material confined within the IHC, resulting in the observed good treatment outcome with catheter drainage.
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Affiliation(s)
- Kazuhiko Morii
- Department of Hepatology, Japanese Red Cross Society Himeji Hospital, Japan
| | - Takeharu Yamamoto
- Department of Hepatology, Japanese Red Cross Society Himeji Hospital, Japan
| | | | - Hiroaki Okushin
- Department of Hepatology, Japanese Red Cross Society Himeji Hospital, Japan
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16
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Vernuccio F, Ronot M, Dioguardi Burgio M, Lebigot J, Allaham W, Aubé C, Brancatelli G, Vilgrain V. Uncommon evolutions and complications of common benign liver lesions. Abdom Radiol (NY) 2018; 43:2075-2096. [PMID: 29260281 DOI: 10.1007/s00261-017-1427-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Frequently encountered on abdominal imaging studies, the majority of common benign liver lesions are asymptomatic, confidently diagnosed by imaging, and do not require further workup, follow-up, or treatment. The increasing use of multimodality liver imaging, has allowed the recognition of uncommon evolutions of common benign liver lesions such as size changes, fibrotic regression, and content and vascularization changes, and their complications such as rupture, hemorrhage, thrombosis, extrinsic compression, and malignancy. The purpose of this pictorial review is to describe and illustrate the incidence and diagnostic features of these uncommon evolutions and complications on cross-sectional imaging, mainly on computed tomography and magnetic resonance imaging, with emphasis on those imaging clues which are helpful in the differential diagnosis or indicate the need for treatment.
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17
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A case of inferior vena cava thrombosis caused by compression due to growing giant liver cyst. Clin J Gastroenterol 2018; 12:71-75. [PMID: 30039460 DOI: 10.1007/s12328-018-0885-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 07/09/2018] [Indexed: 10/28/2022]
Abstract
We report a case of inferior vena cava (IVC) thrombosis caused by compression by a giant liver cyst. A 68-year-old man with a 1-day history of abdominal pain was referred to another hospital. Ultrasonography (US) and enhanced computed tomography (CT) showed a multilobular cyst on the right liver lobe that had increased to 300 mm in diameter from 90 mm 18 months earlier. Thrombosis was detected in the IVC, which was compressed by the cyst. Percutaneous transhepatic cyst drainage achieved no significant change in size. Cytological analysis from the percutaneous drainage tube fluid showed no evidence of malignancy. He was referred to our hospital for further assessment and treatment. Enhanced US using perfluorobutane, CT, and magnetic resonance imaging showed no tumorous lesions in the cyst. Thus, we diagnosed it as a multilobular cyst with no evidence of malignancy. A 3-week course of heparin resulted in the successful resolution of the thrombosis. Cystectomy was subsequently performed and pathological examination showed a multifocal cyst consisting of central suppurative inflammatory exudation and hemorrhagic material, with no malignancy. This case demonstrates that giant, expanding, non-tumorous cysts can cause IVC thrombosis. Careful treatment using heparin successfully resolved the thrombosis and allowed successful cystectomy.
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18
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van Aerts RMM, van de Laarschot LFM, Banales JM, Drenth JPH. Clinical management of polycystic liver disease. J Hepatol 2018; 68:827-837. [PMID: 29175241 DOI: 10.1016/j.jhep.2017.11.024] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 09/20/2017] [Accepted: 11/18/2017] [Indexed: 12/22/2022]
Abstract
A 41-year old female underwent a computed tomography (CT) scan in 2010 because of symptoms suggestive of appendicitis. Incidentally, multiple liver lesions characterised as cysts were detected. The presence of small to medium sized liver cysts (diameter between <1 cm and 4 cm) in all liver segments (>100 cysts) and absence of kidney cysts in the context of normal renal function led to the clinical diagnosis of autosomal dominant polycystic liver disease (ADPLD). Five years later she was referred to the outpatient clinic with increased abdominal girth, pain in the right upper abdomen and right flank, and early satiety. She had difficulties bending over and could neither cut her toenails nor tie her shoe laces. In her early twenties she had used oral contraception for five years. She has been pregnant twice. Clinical examination showed an enlarged liver reaching into the right pelvic region and crossing the midline of the abdomen. Laboratory testing demonstrated increased gamma-glutamyl transferase (80 IU/L, normal <40 IU/L) and alkaline phosphatase (148 IU/L, normal <100 IU/L) levels. Bilirubin, albumin and coagulation times were within the normal range. A new CT scan in 2015 was compatible with an increased number and size of liver cysts. The diameter of cysts varied between <1 cm and 6 cm (anatomic distribution shown [Fig. 2B]). There were no signs of hepatic venous outflow obstruction, portal hypertension or compression on the biliary tract. Height-adjusted total liver volume (htTLV) increased from 2,667 ml/m in 2012 to 4,047 ml/m in 2015 (height 172 cm). The case we present here is not uncommon, and prompts several relevant questions.
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Affiliation(s)
- René M M van Aerts
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Jesus M Banales
- Department of Liver and Gastrointestinal Diseases, Biodonostia Research Institute - Donostia University Hospital, University of the Basque Country (UPV/EHU), IKERBASQUE, CIBERehd, San Sebastián, Spain
| | - Joost P H Drenth
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands.
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Abstract
Liver cysts are commonly found incidentally from imaging scans or at autopsy. These benign neoplasms vary in size and represent a heterogeneous group of disorders, for which the demographics, risk factors, apparent inciting event, clinical presentation, and outcome are varied. Complications that can develop from a liver cyst include development of spontaneous hemorrhage, infection, and/or obstruction. Although the etiology of liver cysts varies, fatal rupture of a hemorrhagic liver cyst due to anabolic steroid use is a rare occurrence. In fact, there are few reported cases in journal literature. We report a case of a fatal liver cyst rupture with resultant hemoperitoneum in the presence of anabolic steroid (stanozolol) use.
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Wang SH, Liu CH, Lin YP, Chang WK. Hypovolemic Shock Caused by a Ruptured Hemorrhagic Hepatic Cyst. J Emerg Med 2015; 49:e93-4. [PMID: 25934380 DOI: 10.1016/j.jemermed.2015.02.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 02/07/2015] [Accepted: 02/18/2015] [Indexed: 12/13/2022]
Affiliation(s)
- Sheng-Huei Wang
- Department of Internal Medicine Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Chang-Hsien Liu
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Yu-Pang Lin
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Wei-Kuo Chang
- Department of Internal Medicine Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
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21
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Simon T, Bakker IS, Penninga L, Nellensteijn DR. Haemorrhagic rupture of hepatic simple cysts. BMJ Case Rep 2015; 2015:bcr-2014-208676. [PMID: 25697302 DOI: 10.1136/bcr-2014-208676] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Haemorrhagic rupture is a life-threatening complication of a hepatic simple cyst. A 63-year-old man presented with severe acute abdominal pain and a massive haemoperitoneum resulting from haemorrhagic rupture of a large hepatic cyst. The haemorrhagic rupture was aggravated by an overdose of vitamin K-antagonist treatment. CT scans revealed a large hepatic simple cyst. The patient was successfully treated conservatively with resuscitation, transfusion therapy and administration of coagulation agents. To date, there is no clear evidence regarding optimal treatment of haemorrhagic hepatic cyst rupture. The risk of recurrent bleeding from the haemorrhagic hepatic simple cyst, and the need for final treatment to avoid rebleeding either by percutaneous sclerotherapy, endovascular embolisation, surgical cyst resection, or surgical deroofing, is discussed.
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Affiliation(s)
- Tiarah Simon
- Department of Surgery, St Elisabeth Hospital, Willemstad, Curaçao
| | | | - Luit Penninga
- Department of Surgery, St Elisabeth Hospital, Willemstad, Curaçao
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22
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Tanaka T, Gobara H, Tomita K, Hiraki T, Tanaka T, Kanazawa S. Hepatic Intracystic Organizing Hematoma Mimicking Biliary Cystadenocarcinoma in a Patient with Polycystic Liver Disease. Intern Med 2015; 54:2001-5. [PMID: 26278291 DOI: 10.2169/internalmedicine.54.4218] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Hepatic intracystic hemorrhage is a rare complication of polycystic liver diseases, such as autosomal dominant polycystic kidney disease (ADPKD). A hepatic cyst with mural nodules and septation may suggest the presence of a cystic malignancy, such as biliary cystadenocarcinoma. We herein report a case of hepatic intracystic hematoma with a mural nodule mimicking biliary cystadenocarcinoma in a patient with ADPKD. Hepatic intracystic hemorrhage with a mural nodule is a very rare occurrence. A fat-saturated T1-weighted magnetic resonance image may be useful for making an accurate diagnosis of intracystic hematoma.
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Affiliation(s)
- Takashi Tanaka
- Department of Radiology, Okayama University Medical School, Japan
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23
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ACG clinical guideline: the diagnosis and management of focal liver lesions. Am J Gastroenterol 2014; 109:1328-47; quiz 1348. [PMID: 25135008 DOI: 10.1038/ajg.2014.213] [Citation(s) in RCA: 244] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 05/22/2014] [Indexed: 12/11/2022]
Abstract
Focal liver lesions (FLL) have been a common reason for consultation faced by gastroenterologists and hepatologists. The increasing and widespread use of imaging studies has led to an increase in detection of incidental FLL. It is important to consider not only malignant liver lesions, but also benign solid and cystic liver lesions such as hemangioma, focal nodular hyperplasia, hepatocellular adenoma, and hepatic cysts, in the differential diagnosis. In this ACG practice guideline, the authors provide an evidence-based approach to the diagnosis and management of FLL.
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24
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Hemorrhagic hepatic cyst after allogeneic bone marrow transplantation. Int J Hematol 2014; 100:214-5. [PMID: 25037268 DOI: 10.1007/s12185-014-1640-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 07/06/2014] [Accepted: 07/08/2014] [Indexed: 10/25/2022]
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25
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Kelly K, Weber SM. Cystic diseases of the liver and bile ducts. J Gastrointest Surg 2014; 18:627-34; quiz 634. [PMID: 24356979 DOI: 10.1007/s11605-013-2426-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 11/21/2013] [Indexed: 02/07/2023]
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Benzimra J, Ronot M, Fuks D, Abdel-Rehim M, Sibert A, Farges O, Vilgrain V. Hepatic cysts treated with percutaneous ethanol sclerotherapy: time to extend the indications to haemorrhagic cysts and polycystic liver disease. Eur Radiol 2014; 24:1030-8. [PMID: 24563160 DOI: 10.1007/s00330-014-3117-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 01/14/2014] [Accepted: 02/05/2014] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To describe the long-term clinical and morphological outcome of symptomatic hepatic cysts treated with percutaneous ethanol sclerotherapy (PES). METHODS From December 2003 to September 2011, all patients with hepatic cysts undergoing PES with a follow-up after 12 months were included. Evolution of the volume of the cysts and clinical and biological data were recorded. Features of the cyst were evaluated in each patient: simple, haemorrhagic or developed on underlying polycystic liver disease (PCLD). RESULTS Fifty-eight cysts (median volume 666 mL) were treated in 57 patients (52 women, mean age 58 years (18-80)). Twenty-two patients (39 %) had simple hepatic cysts, 19 (33 %) had dominant cysts on PCLD and 20 had haemorrhagic cysts (34.5 %), including 4 with PCLD. After a mean 27.3 months of follow-up, the final median cystic volume was 13.5 mL (p < 0.0001), and the median reduction in cyst volume was 94 % (58-100 %). Treatment was satisfactory in 95 % of the patients (54/57) (symptoms disappeared in 45/57 (79 %), decreased in 9/57 (16 %)). There was no clinical or morphological difference between patients with PCLD, haemorrhagic cysts or simple cysts. CONCLUSION The clinical and morphological efficacy of a single session of PES is very high, regardless of the presence of intracystic haemorrhage or underlying PCLD. KEY POINTS • The clinical efficacy of percutaneous ethanol sclerotherapy is very high. • Haemorrhagic content should not be a contraindication for percutaneous sclerotherapy. • Dominant cysts on polycystic liver disease should be treated with PES. • Imaging follow-up should not be performed shortly after the procedure.
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Affiliation(s)
- Julie Benzimra
- Department of Radiology, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France
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Tonolini M, Crespi M, Bianco R. Magnetic resonance imaging clinches diagnosis of haemorrhagic liver cyst. Dig Liver Dis 2013; 45:1061. [PMID: 23891498 DOI: 10.1016/j.dld.2013.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 05/29/2013] [Accepted: 05/30/2013] [Indexed: 12/11/2022]
Affiliation(s)
- Massimo Tonolini
- Department of Radiology, "Luigi Sacco" University Hospital, Milano, Italy.
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28
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Imamura H, Kawashita Y, Koga N, Sanada Y, Azuma T, Matsuo S, Eguchi S. A large hepatic cyst with obstructive jaundice successfully treated with single-incision laparoscopic deroofing. Case Rep Gastroenterol 2013; 7:503-10. [PMID: 24474900 PMCID: PMC3901626 DOI: 10.1159/000357304] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
We herein present a case of hepatic cysts causing obstructive jaundice that was treated with single-incision laparoscopic deroofing. A 72-year-old female patient was referred to hospital due to a large hepatic cyst that compressed the intrahepatic bile ducts. The patient was scheduled to undergo single-incision laparoscopic deroofing. The EZ ACCESS(TM) oval type (Hakko Co. Ltd.) was placed at the umbilicus using a 25-mm incision with two 5-mm trocars. An additional 12-mm port was placed at the left epigastric region. We unroofed and excised the cyst wall using a vessel sealing system in liver segment 4. After surgery, the patient was found to be asymptomatic. The unroofed cysts were completely diminished. Notably, the remnant liver had fairly regenerated. The estimated regeneration volume of the normal liver was 153 cm(3). To prevent surgical complications, clinicians should perform adequate management and use of devices. To prevent postoperative recurrence of cysts, performing complete deroofing is essential. Single-incision laparoscopic deroofing contributes to improving the quality of life of patients and should be considered a standard treatment.
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Affiliation(s)
- Hajime Imamura
- Department of Surgery, Shimabara Hospital, Shimabara, Nagasaki, Japan
| | - Yujo Kawashita
- Department of Surgery, Shimabara Hospital, Shimabara, Nagasaki, Japan
| | - Naoki Koga
- Department of Surgery, Shimabara Hospital, Shimabara, Nagasaki, Japan
| | - Yuichi Sanada
- Department of Surgery, Shimabara Hospital, Shimabara, Nagasaki, Japan
| | - Takashi Azuma
- Department of Surgery, Shimabara Hospital, Shimabara, Nagasaki, Japan
| | - Shigetoshi Matsuo
- Department of Surgery, Shimabara Hospital, Shimabara, Nagasaki, Japan
| | - Susumu Eguchi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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29
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Symptomatic and complicated nonhereditary developmental liver cysts: cross-sectional imaging findings. Emerg Radiol 2013; 21:301-8. [DOI: 10.1007/s10140-013-1179-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 11/07/2013] [Indexed: 01/23/2023]
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