Marrero JA, Ahn J, Rajender Reddy K, American College of Gastroenterology. ACG clinical guideline: the diagnosis and management of focal liver lesions. Am J Gastroenterol. 2014 Sep;109(9):1328-47; quiz 1348. doi: 10.1038/ajg.2014.213. Epub 2014 Aug 19. PMID: 25135008.
A simple hepatic cyst is most often a single, round or oval lesion ≤10 cm in diameter, but the presence of several cysts of different sizes is also possible. Simple hepatic cysts have fibrous capsules and serous contents. In rare cases of bleeding into the cyst, the contents take on a dusty gray color. The liver parenchyma outside the cysts is normal.
Clinical features: Simple liver cysts are usually asymptomatic and detected incidentally on imaging performed for other reasons. Large cysts (>10 cm) can cause pain, discomfort, and the feeling of fullness and pressure in the upper abdomen. Sometimes distention and early satiety are present (due to pressure on the stomach). Jaundice, ascites, and obstruction of blood outflow through the hepatic veins appear rarely. Acute pain in the right upper abdomen may indicate bleeding into the lumen of the cyst.
Diagnosis is usually based on typical imaging findings (see Table 7.3-1); drainage of the cyst is not necessary.
Treatment is indicated only in patients with symptomatic cysts. The most common laparoscopic technique is excision of the anterior cyst wall and its histologic examination along with cytologic and microbiologic examination of fluid from the cyst lumen. Sometimes the surgical procedure involves enucleation of the cyst or resection of the liver parenchyma together with the cyst. Simple liver cysts are not a contraindication to pregnancy. Periodic ultrasonography should be performed in pregnant women.