Simple hepatic cyst
Updates to Article Attributes
Simple hepatic cysts are are common benign liver lesions and have no malignant potential. They can be diagnosed on ultrasound, CT, or MRI.
Epidemiology
There oneSimple hepatic cysts are one of the commonest of liver liver lesions and occur, occurring in ~2-7% of the population1-2. There may be a slight female predilection.
Clinical presentation
Hepatic cysts are typically discovered incidentally and are almost always asymptomatic.
Pathology
These lesionsSimple hepatic cysts may be isolated or multiple and may vary from a few millimeters to several centimeters in diameter. Simple hepatic cysts are benign developmental lesions that do not communicate with the biliary tree2. The current theory regarding the origin of true hepatic cysts is that they originate from hamartomatous tissue. On histopathological analysis, true hepatic cysts contain serous fluid and are lined by a nearly imperceptible wall consisting of cuboidal epithelium, identical to that of bile ducts, and a thin underlying rim of fibrous stroma2.
Location
While they can occur anywhere in the liver, there may be a greater predilection towards the right lobe of the liver3 (Wonder why ? more liver tissue ?).
Associations
Certain diseases are associated with multiple hepatic cysts and include
- polycystic liver disease
-
polycystic kidney disease:autosomal dominant polycystic kidney disease (ADPKD): hepatic cysts may be seen in ~40% of those with ADPKD2. - von Hippel
lindauLindau disease
Radiographic features
General imaging features
They are typically round or ovoid in shape and have well-defined margins.
Ultrasound
- round or ovoid anechoic lesion (may be lobulated)
- well-marginated with a thin or imperceptible wall and a clearly defined back wall
- may show posterior acoustic enhancement, if large enough
- a few septa may be possible, but no wall thickening
- a small amount of layering debris is possible
- no internal vascularity on colour Doppler
CT
On CT, a hepatic cyst demonstrates homogenous hypoettenuationhomogeneous hypoattenuation (water attenuation) with around 0-10 HU. The wall is usually imperceptible, and the cyst does not enhance after intravenous administration of contrast material.
MRI
On MR imaging a hepatic cyst havefollows the signal characteristics iso-intense relative to water and does not enhance after administrationintensity of contrast. The cyst wall is very thin or even imperceptible 4.
Therefore signal characteristics are water on all sequences:
- T1: homogeneous very low signal intensity
-
T2:
increase inincreased signal intensity, greater than other T2 hyperintense liver lesions (e.g. haemangioma)
In instances of intracystic haemorrhage, which is a rare complication in simple hepatic cysts, the signal intensity is high, with a fluid-fluid level, on both T1- and T2-weighted images when mixed blood products are present2.
A hepatic cyst does not enhance after administration of contrast. The cyst wall is very thin or even imperceptible 4.
Differential diagnosis
General imaging differential considerations include othercystic liver lesions, including:
- hepatic hydatid cyst(s)
- hepatic abscess(es)
- hepatic haemangioma
- biliary cystadenoma(s)
- choledochal cyst: communicates with biliary tree
- necrotic hepatic metastasis (would probably have lower T2 than a cyst, higher CT attenuation, and enhancement of a thickened wall)
On CT and T2 MRI images also consider:
On the LI-RADS classification system, a simple cyst is given a designation of LR1 or LR2.
-<p><strong>Simple hepatic cysts</strong> are common benign liver lesions and have no malignant potential.</p><h4>Epidemiology</h4><p>There one of the commonest of liver lesions and occur in ~2-7% of the population <sup>1-2</sup>. There may be a slight female predilection.</p><h4>Clinical presentation</h4><p>Hepatic cysts are typically discovered incidentally and almost always asymptomatic.</p><h4>Pathology</h4><p>These lesions may be isolated or multiple and vary from a few millimeters to several centimeters in diameter. Simple hepatic cysts are benign developmental lesions that do not communicate with the biliary tree <sup>2</sup>. The current theory regarding the origin of true hepatic cysts is that they originate from hamartomatous tissue. On histopathological analysis, true hepatic cysts contain serous fluid and are lined by a nearly imperceptible wall consisting of cuboidal epithelium, identical to that of bile ducts, and a thin underlying rim of fibrous stroma <sup>2</sup>.</p><h5>Location</h5><p>While they can occur anywhere in the liver, there may be greater predilection towards the right lobe of the liver <sup>3</sup> (Wonder why ? more liver tissue ?).</p><h5>Associations</h5><p>Certain diseases are associated with multiple hepatic cysts and include</p><ul>- +<p><strong>Simple hepatic cysts</strong> are common benign liver lesions and have no malignant potential. They can be diagnosed on ultrasound, CT, or MRI.</p><h4>Epidemiology</h4><p>Simple hepatic cysts are one of the commonest liver lesions, occurring in ~2-7% of the population <sup>1-2</sup>. There may be a slight female predilection.</p><h4>Clinical presentation</h4><p>Hepatic cysts are typically discovered incidentally and are almost always asymptomatic.</p><h4>Pathology</h4><p>Simple hepatic cysts may be isolated or multiple and may vary from a few millimeters to several centimeters in diameter. Simple hepatic cysts are benign developmental lesions that do not communicate with the biliary tree <sup>2</sup>. The current theory regarding the origin of true hepatic cysts is that they originate from hamartomatous tissue. On histopathological analysis, true hepatic cysts contain serous fluid and are lined by a nearly imperceptible wall consisting of cuboidal epithelium, identical to that of bile ducts, and a thin underlying rim of fibrous stroma <sup>2</sup>.</p><h5>Location</h5><p>While they can occur anywhere in the liver, there may be a greater predilection towards the right lobe of the liver <sup>3</sup>.</p><h5>Associations</h5><p>Certain diseases are associated with multiple hepatic cysts and include</p><ul>
-<li>polycystic kidney disease: <a href="/articles/autosomal-dominant-polycystic-kidney-disease-1">autosomal dominant polycystic kidney disease (ADPKD)</a>: hepatic cysts may be seen in ~40% of those with ADPKD <sup>2</sup>.</li>-<li><a href="/articles/von-hippel-lindau-disease-5">von Hippel lindau disease</a></li>-</ul><h4>Radiographic features</h4><h5>General imaging features</h5><p>They are typically round or ovoid in shape and have well-defined margins</p><h5>CT</h5><p>On CT, a hepatic cyst demonstrates homogenous hypoettenuation (water attenuation) with around 0-10 HU. The wall is usually imperceptible, and the cyst does not enhance after intravenous administration of contrast material</p><h5>MRI</h5><p>On MR imaging a hepatic cyst have signal characteristics iso-intense relative to water and does not enhance after administration of contrast. The cyst wall is very thin or even imperceptible <sup>4</sup>.</p><p>Therefore signal characteristics are:</p><ul>- +<li>
- +<a href="/articles/autosomal-dominant-polycystic-kidney-disease-1">autosomal dominant polycystic kidney disease (ADPKD)</a>: hepatic cysts may be seen in ~40% of those with ADPKD <sup>2</sup>.</li>
- +<li><a href="/articles/von-hippel-lindau-disease-5">von Hippel Lindau disease</a></li>
- +</ul><h4>Radiographic features</h4><h5>General imaging features</h5><p>They are typically round or ovoid in shape and have well-defined margins.</p><h5>Ultrasound</h5><ul>
- +<li>round or ovoid anechoic lesion (may be lobulated)</li>
- +<li>well-marginated with a thin or imperceptible wall and a clearly defined back wall</li>
- +<li>may show posterior acoustic enhancement, if large enough</li>
- +<li>a few septa may be possible, but no wall thickening</li>
- +<li>a small amount of layering debris is possible</li>
- +<li>no internal vascularity on colour Doppler</li>
- +</ul><h5>CT</h5><p>On CT, a hepatic cyst demonstrates homogeneous hypoattenuation (water attenuation) around 0-10 HU. The wall is usually imperceptible, and the cyst does not enhance after intravenous administration of contrast material.</p><h5>MRI</h5><p>On MR imaging a hepatic cyst follows the signal intensity of water on all sequences:</p><ul>
-<strong>T2: </strong>increase in signal intensity</li>-</ul><p>In instances of intracystic haemorrhage which is a rare complication in simple hepatic cysts, the signal intensity is high, with a fluid-fluid level, on both T1- and T2-weighted images when mixed blood products are present <sup>2</sup>.</p><h4>Differential diagnosis</h4><p>General imaging differential considerations include other <a href="/articles/missing">cystic liver lesions</a>, including:</p><ul>- +<strong>T2: </strong>increased signal intensity, greater than other T2 hyperintense liver lesions (e.g. haemangioma)</li>
- +</ul><p>In instances of intracystic haemorrhage, which is a rare complication in simple hepatic cysts, the signal intensity is high, with a fluid-fluid level on both T1- and T2-weighted images when mixed blood products are present <sup>2</sup>.</p><p>A hepatic cyst does not enhance after administration of contrast. The cyst wall is very thin or even imperceptible <sup>4</sup>.</p><h4>Differential diagnosis</h4><p>General imaging differential considerations include other <a href="/articles/missing">cystic liver lesions</a>, including:</p><ul>
- +<li><a href="/articles/hepatic-haemangioma-3">hepatic haemangioma</a></li>
-</ul><p>On CT and T2 MRI images also consider:</p><ul><li><a href="/articles/multiple-biliary-hamartomas-1">biliary hamartomas</a></li></ul>- +<li>necrotic <a href="/articles/hepatic-metastases-1">hepatic metastasis</a> (would probably have lower T2 than a cyst, higher CT attenuation, and enhancement of a thickened wall)</li>
- +</ul><p>On CT and T2 MRI images also consider:</p><ul><li><a href="/articles/multiple-biliary-hamartomas-1">biliary hamartomas</a></li></ul><p>On the <a href="/articles/li-rads">LI-RADS</a> classification system, a simple cyst is given a designation of LR1 or LR2.</p>
Tags changed:
- liver
- ultrasound
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