Hepatic Cystadenomas Clinical Presentation
- Author: Krishan Ariyarathna, MD; Chief Editor: BS Anand, MD more...
Hepatic cystadenomas are often discovered incidentally at a routine physical examination or on imaging studies, such as ultrasound (US) or CT scan. Less frequently, nonspecific symptoms related to compression of a neighboring organ may be noted. Presenting symptoms depend on the size and the location of the lesion. The final diagnosis is made after surgical resection. Note the following:
- Roughly 15% of patients present with small intrahepatic lesions, which are usually asymptomatic and discovered incidentally after screening ultrasonography.
- For larger lesions, the typical presentation is that of an expanding mass in the right upper quadrant accompanied by pain, nausea, vomiting, and, in selected cases, cholangitis and sepsis.
Physical examination findings from patients with hepatic cystadenomas are usually unremarkable unless the tumor has reached a significant size and causes compressive symptoms. Physical examination may reveal a palpable and tender mass in the right upper quadrant or epigastrium and, less commonly, hepatomegaly. Lower-extremity edema and/or signs of portal hypertension may occur in patients with lesions large enough to compress the portal vein or vena cava. Note the following:
- Splenomegaly may be an indication of a compressive effect on the portal circulation, with the development of portal hypertension. These patients also may develop ascites.
- Jaundice suggests obstruction of the biliary system. Rare extension of the lesion in a pedunculated fashion inside the biliary system has been described.
- Obstruction of the inferior vena cava may cause marked lower-extremity edema.
- In the rare occurrence of intraperitoneal rupture of the lesion, the patient may have signs typical of acute peritonitis.
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