Patients that underwent surgery for noninfective liver cysts from January 2003 to July 2017 were identified from our tertiary liver unit database
The primary diagnostic imaging was retrospectively reviewed,
and key diagnostic features were identified and correlated with histological findings.
Cysts were specifically evaluated for enhancing thick septations,
intra-cystic nodules,
calcification,
solid elements,
intra-cystic debris and biliary dilatation.
The study included 51 patients who underwent surgery.
There were 44 females and 7 males with Female to male ratio 6:1( Figure 1).
The mean age was 63 years (range 40-92 years) and the mean size of the cysts was 13.5cm (range 3.5 - 28cm).
55% of patients underwent surgery for pain and discomfort,
9% for early satiety,
8% for shortness of breath,
13% were asymptomatic liver cysts that had complex imaging features and 15% due to case specific causes.
Case specific symptoms included symptoms of IVC compression,pedal oedema,
hepatic venous obstruction,
encephalopathy and hyponatraemia (Figure 3).
Surgery ranged from de-roofing to surgical excision.
On initial imaging the majority 24 cases (47%) were simple cysts (SLC),
17(33%) were complex liver cysts (CLC) and 20% were polycystic liver disease (PCLD) (Figure 4).
Correlation with histology confirmed 32(63%) were simple cysts,
9(17%) were complex cysts and 10 (20%) were polycystic liver cysts (Figure 5).
9 of the cysts (47%) described on imaging as CLC were confirmed to be SLC on final histology.
6 (75%) of them contained haemorrhagic products while 4(50%) had features of chronic inflammation.
All of the polycystic liver disease cysts were diagnosed accurately (Figure 6).
2 patients (12%) with malignancy and 7(41%) with a premalignant lesion and the remaining 8(47%) were SLC Containing either haemorrhaging products or chronic inflammatory changes.
The majority of CLC demonstrated septations (76%),
while intracystic nodules/solid elements were seen in 53% (n=9),
calcifications in 23% and intracystic debris was seen in 17% ( Figure 8).
6 of 9 (66%) cases with malignant/premalignant complex cysts had intracystic nodules and solid elements on imaging and 2 of 9 (22%) of cases had calcification.
The most common diagnosis in patients with CLC was biliary cystadenoma.