Most cystic liver lesions are benign, and there is a tendency to overinvestigate them. Dr Nicoll presents her approach to management.
- Simple liver cysts are common, with a prevalence of 2.5% in the population (women:men, 4:1). The incidence increases with age.
- Most simple cysts are asymptomatic, but symptoms can occur due to mass effect, rupture, haemorrhage or infection.
- Simple cysts have a characteristic ultrasound image: echo-free, round structures with posterior acoustic enhancement; thin septations may be present. Features suggestive of an abscess or a cystic neoplasm include thick septations, an associated mass, and increased vascularity.
- Simple cysts contain serous fluid.
- Multiple liver or renal cysts may suggest polycystic liver disease. The liver is involved in 50% of cases of adult polycystic kidney disease.