Liver Cysts: Simple Cysts Flashcards
What are the 4 anatomical lobes of the liver?
Left, right, caudate and quadrate.
What are simple liver cysts?
Simple liver cysts are simple fluid-filled epithelial-lined sacs within the liver, most commonly occurring in the right lobe. They are relatively common, with a prevalence of 2.5-18%, increasing in incidence with age.
Briefly describe the pathophysiology of simple liver cysts
They are thought to be due to congenitally malformed bile duct cells, failing to connect to the extrahepatic ducts, which leads to a local dilatation filled with a bile-like fluid, of varying size.
What are the clinical features of simple liver cysts?
Simple cysts are normally asymptomatic and often detected incidentally on imaging.
Around 10-15% of patients experience symptoms such as abdominal pain, nausea and early satiety (typically due to mass effect on surrounding structures).
What investigations should be ordered for simple liver cysts?
LFTs are typically normal, although a small number of patients may have a raised GGT. Tumour markers CEA and CA19-9 can also be elevated in some cases.
Ultrasound remains the imaging modality of choice for investigating suspected liver cysts.
How do simple liver cysts appear on ultrasound scan?
Simple cysts are characteristically anechoic, well-defined, thin-walled (often imperceptible), oval/spherical lesions with no septations, and strong posterior wall acoustic enhancement.
Briefly describe the management of simple liver cysts
Most cysts require no intervention, though for cysts >4cm in size, follow-up ultrasound scans are recommended at 3, 6 and 12 months post-detection to check for growth. If the size of the cyst remains unchanged after 2-3 years, no further scans are required unless the patient becomes symptomatic.
If the patient is symptomatic or the diagnosis is uncertain, further intervention may be warranted. Options include ultrasound-guided aspiration or laparoscopic de-roofing, with the latter having lower rates of failure and recurrence.
