POSTER SECTIONS Coverpage Learning objectives Background Findings and procedure details Conclusion Personal information References

ECR 2019 / C-2119

Hepatic cystic lesion: what radiologist should know?

Congress:

ECR 2019

Poster Number:

C-2119

Type:

Educational Exhibit

Keywords:

Liver, Ultrasound, CT, MR, Biopsy, Pathology, Cysts, Tissue characterisation

Authors:

J. HABI, H. GUERROUM, M. KASSIMI, A. Rami, N. Moussali, N. Chikhaoui, M. MAHI, I. Rahmouni; Casablanca/MA

DOI:

10.26044/ecr2019/C-2119

DOI-Link:

https://dx.doi.org/10.26044/ecr2019/C-2119

Fig. 1: US: Right hepatic simple cyst (Star) posterior strengthening (Arrow)

Fig. 2: CT scan without and with injection: White arrow: Left hepatic rounded lesion,...

Fig. 3: T2-weighted MR image in 45-year-old woman shows homogeneously hyperintense...

Fig. 4: CT Scan: percutaneous drainage with sclerotherapy

Fig. 5: Biliary hamartoma in 35 years old woman. A: Axial T2-fat-suppressed MR image...

Fig. 6: US: (Caroli disease) Multiple cystic dilations (arrow) that communicate with...

Fig. 7: Caroli disease in 35-year-old man. Contrast-enhanced portal venous phase CT...

Fig. 8: Autosomal dominant polycystic disease in 40-year-old man with known polycystic...

Fig. 9: Example of ciliated cyst in a woman 76 years old. Ultrasound finds a hypoechoic...

Fig. 10: Hepatic abscess with septic thrombophlebitis. A: Axial T2-weighted fat-sat...

Fig. 11: Hydatic cyst Type II of Gharby classification. US: fluid formation anechoic,...

Fig. 12: Multilocular hydatic hepatic cyst type III of Gharby classification.

Fig. 13: Biliary cystadenoma in 47-year-old woman. Contrast-enhanced CT scan shows...

Fig. 14: Cystic hepatocellular carcinoma in 60-year-old man with known hepatocellular...

Fig. 15: computed tomography image: Showing two large cystic-appearing liver lesions...

Fig. 16: Subcapsular hematoma CT scan shows well-circumscribed elliptical area of...

Fig. 17: Intrahepatic. CT scan shows well-circumscribed fluid-density collection within...

Fig. 18: Pseudocyst related to prior episode of pancreatitis in 45-year-old man. A:...

Fig. 19: Hepatic cystic abnormalities.

Table 1: Distinguishing charateristics of simple and complexe cysts.

Table 2: Apprearance of simple versus complex hepatic cysts with various imaging...

Learning objectives

Describe and illustrate the different hepatic cystic lesions. Propose a practical algorithm for approaching the diagnosis.

Background

Cystic liver disease encompasses a heterogeneous group of fluid-filled lesions within the liver parenchyma [1]. Hepatic cysts are most often discovered incidentally on imaging. Cysts are the most commonly encountered hepatic lesion, occurring in 2.5% of the general population [2]. The diagnostic approach of benign and malignant lesions is done by studying the morphology, the number and tissue content of lesions. Imaging with conventional ultrasound, computed tomography, magnetic resonance imaging, or contrast-enhanced ultrasound can be used to further characterize and diagnose HCs: Ultrasound is typically...

Findings and procedure details

The first step in diagnosis is stratifying risk by differentiating simple and complex cysts. Simple cysts have: Thin, smooth walls and may contain up to two septae. Complex cysts have: Septated, mural irregularity or nodularity, debris, calcification, and fluid levels. (Table 1 -2) The simple cyst includes developmental lesions: o Simple cyst: A benign, congenital, and developmental lesion derived from biliary endothelium that does not communicate with the biliary tree. Multiple, round or ovoid structures without a perceptible wall. § US: oval or rounded lesion,...

Conclusion

Hepatic cystic disease can be subdivided into simple and complex cysts, according to semiological characteristics of the lesions. There are several modalities that are useful in characterizing Hepatic Cystic, including conventional US, CT, MRI, and contrast-enhanced ultrasound. It is also necessary to integrate imaging with clinical and laboratory findings to help the radiologist to establish a definitive diagnosis or provide a reasonable differential diagnosis.

Personal information

J. HABI, H. GUERROUM, M. KASSIMI, A. Rami, N. Moussali, N. Chikhaoui, M. MAHI, I. Rahmouni Radiology.Congenital, Surgery, Ultrasound, MR, CT, Oncology, Vascular. Casablanca, Morocco. J.HABI Radiology Resident. University Mohammed VI, Hospital Cheikh Khalifa. Casablanca, Morocco Email: [email protected]

References

[1]: Marianna G. Mavilia et al. (2018) Differentiating Cystic Liver Lesions: A Review of Imaging Modalities, Diagnosis and Management: Journal of Clinical and Translational Hepatology 2018 vol. 6 | 208–216. [2]: Cystic Hepatic Lesions: A Review and an Algorithmic Approach: Amir A. Borhani Amanda Wiant Matthew T. Heller 2014 [3] Lantinga MA, Gevers TJ, Drenth JP. Evaluation of hepatic cystic lesions. World J Gastroenterol 2013;19:3543– 3554. doi: 10.3748/wjg.v19.i23.3543. [4]: Scherer K, Gupta N, Caine WP, Panda M. Differential diagnosis and manage-ment of a recurrent hepatic...