Hepatic Cysts Clinical Presentation

Updated: Jun 08, 2017
  • Author: Robert E Glasgow, MD; Chief Editor: John Geibel, MD, DSc, MSc, AGAF  more...
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Presentation

History and Physical Examination

Simple cysts

Simple cysts generally cause no symptoms but may produce dull right-upper-quadrant pain if large in size. Patients with symptomatic simple liver cysts may also report abdominal bloating and early satiety. Occasionally, a cyst is large enough to produce a palpable abdominal mass. Jaundice caused by bile duct obstruction is rare, as are cyst rupture and acute torsion of a mobile cyst. Patients with cyst torsion may present with an acute abdomen. When simple cysts rupture, patients may develop secondary infection, leading to a presentation similar to a hepatic abscess with abdominal pain, fever, and leukocytosis.

Polycystic liver disease

Polycystic liver disease (PCLD) rarely arises in childhood. These cysts are observed at the time of puberty and increase in adulthood. They occur as part of a congenital disorder associated with polycystic kidney disease (PKD). Women are more commonly affected, and an increase in cyst size and number is correlated with estrogen level. In PCLD, hepatomegaly may be prominent, and patients occasionally progress to hepatic fibrosis, portal hypertension, and liver failure. Complications (eg, rupture, hemorrhage, and infection) are rare. However, patients do present with abdominal pain as the cysts enlarge.

Neoplastic cysts

Cystadenoma most often occurs in middle-aged women. However, cystadenocarcinoma equally affects both men and women. Most patients are asymptomatic or have vague abdominal complaints of bloating, nausea, and fullness. These patients, like all those with hepatic cysts, eventually present with abdominal pain. Rarely, they present with evidence of biliary obstruction.

Hydatid cysts

Patients with hydatid cysts, like those with simple cysts, are most often asymptomatic, but pain may develop as the cyst grows. Larger lesions typically cause pain and are more likely to develop complications than simple cysts. At presentation, patients generally have a palpable mass in the right upper quadrant.

Cyst rupture is the most serious complication of hydatid cysts. Cysts may rupture into the biliary tree, through the diaphragm into the chest, or freely into the peritoneal cavity. Rupture into the biliary tree may result in jaundice or cholangitis. Free rupture into the peritoneal cavity may cause anaphylactic shock. As with simple cysts, patients with hydatid cysts may develop secondary infection and subsequent hepatic abscesses.

Hepatic abscesses

Patients with hepatic abscesses present with abdominal pain, fever, and leukocytosis. Typically, symptoms are vague and relatively nonspecific, and as a result, diagnosis is often delayed. Clinical history is important because of associated illnesses. Those patients with amebiasis can have a history of diarrhea and weight loss, though some may be asymptomatic. Pyogenic abscesses often present with cholangitis, abdominal infections, or sepsis. Rarely, abscesses will rupture, and patients present with peritonitis.