HEPATIC CYSTS 

 

ETIOLOGY
  • Thought to represent growth arrest and dilatation of the biliary tree, however there are few cases with pathological confirmation (1).
  • Liver cysts occur in about 2.5% of the general population and their incidence tends to increase with age. They grow slowly and most are detected in the 4th and 5th decades of life (3)
  • Their etiology is unknown, although, it is hypothesized that such cysts are produced in aberrant bile ducts by either inflammatory or obstructive processes (4) or by a vascular disruption phenomenon during the fetal period (5).
  • Vascular disruption phenomenon (VDP) theory.
  • There is a 4:  female predominance (6).
  • Right lobe of the liver is more commonly affected (6).
  • The cysts are characteristically lined with cuboidal epithelium with no connection to the normal biliary drainage (5).
  • Rare complications in newborns are due to pressure effects (7-9)
  • Asymptomatic cysts do not require surgical intervention, as infection, hemorrhage or rupture are rare findings (4).

 

ULTRASOUND

Two types are described (2):
 

1. Subhepatic / Peripheral cysts

2. Intraparenchymal cysts

 

Differential Diagnosis

Differential Diagnosis

Choledochal Cyst.
Gastrointestinal Duplication Cyst.
Mesenteric Cyst.
Cystic Lymphangioma
Urachal Cyst.
Ovarian Cyst

Cystic Hepatoblastoma.
Mesenchymal Hamartoma.
Vascular Malformation.

 

 

 

REFERENCES
  1. Rypens F, Avni F, Houben JJ et.al. Large solitary non-parasitic cyst of the liver. J Belge Radiol 1993;76:24-25.
  2. Avni EF, Rypens F, Donner C et.al. Hepatic cysts and hyperechogenicities: perinatal assessment and unifying theory on their origin. Pediatr Radiol 1994;24:569-572.
  3. Macken MB, Wright JR Jr, Lau H, Cooper MC, Grantmyre EB, Thompson DL, O'Brien MK. Prenatal sonographic detection of congenital hepatic cyst in third trimester after normal second-trimester sonographic examination. J Clin Ultrasound 2000; 28: 307-10
  4. Tsao L, Jeanty P. Liver cyst. The Fetus 1993; 3: 75164-6
  5. Avni EF, Rypens F, Donner C, Cuvelliez P, Rodesch F. Hepatic cysts and hyperechogenicities: perinatal assessment and unifying theory on their origin. Pediatr Radiol 1994; 24: 569-72
  6. Ishak KG, Sharp HL. Developmental abnormalities and liver diseases in childhood. In: MacSween NM, Anthony PP, Scheurer PJ, eds. Pathology of the Liver 3rd edn. Edinburgh: Churchill Livingstone, 1994: 83-122
  7. Michel W, Albig M, Waldschmidt J, Weitzel H. Prenatal ultrasonic diagnosis of a cystic abdominal tumor-liver cyst and its differential diagnosis. Z Geburtshilfe Perinatol 1986;190:172-4
  8. Merine D, Nussbaum AR, Sanders RC. Solitary nonparasitic hepatic cyst causing abdominal distension and respiratory distress in a newborn. J Pediatr Surg 1990; 25: 349-50
  9. Shankar SR, Parelkar SV, Das SA, Mathure AB. An antenatally-diagnosed solitary, non-parasitic hepatic cyst with duodenal obstruction. Pediatr Surg Int 2000; 16: 214-5