Liver Cysts! A Diagnostic Dilemma
Creators
- 1. Junior Resident, Department of General Surgery, Government Medical College, Chhatrapati Sambhaji Nagar (Aurangabad), Maharashtra
- 2. Professor and Head, Department of General Surgery, Government Medical College, Chhatrapati Sambhaji Nagar (Aurangabad), Maharashtra
- 3. Associate Professor, Department of General Surgery, Government Medical College, Chhatrapati Sambhaji Nagar (Aurangabad), Maharashtra
- 4. Assistant Professor, Department of General Surgery, Government Medical College, Chhatrapati Sambhaji Nagar (Aurangabad), Maharashtra
Description
Introduction: Cystic lesions within the liver are reported to occur in up to 5% of the population. Most of them are common and benign, but the possibility of a rarer cystic liver lesion should not be overlooked. They can present with general or specific symptoms. Most are found incidentally on imaging studies. None of the haematological and biochemical parameters were suggestive of liver cyst. We report this case because of its unusual presentation and associated findings. Case scenario: A 66 years old lady presented to general surgery OPD with complaints of mass per abdomen for 3-4 months and pain in abdomen for 2 months. On Examination: A 10X10cm bulge was visible in hypogastric, left hypochondriac and umbilical region. Lump was moving with respiration and was reducing in size on leg raising test. Cystic in consistency, swelling was moving in horizontal direction and dull on percussion. Investigations: CBC, LFT, KFTS, Serum amylase and lipase, chest and abdominal X-ray showed no major abnormality. Upper GI scopy showed bulging posterior wall of stomach suggestive of lump arising behind the stomach. Ultrasound of abdomen was suggestive of two cystic lesions possibly a simple biliary cyst and a pseudocyst of pancreas. Management: Patient underwent exploratory laparotomy with marsupialization and drain placement in both the cysts with left hepatic lobe contained hemorrhagic fluid and the right hepatic lobe contained straw colored fluid. Conclusion: Cystic liver lesions require accurate pre-treatment diagnosis in order to select the appropriate therapy for each patient, as they can represent benign or malignant formations.
Abstract (English)
Introduction: Cystic lesions within the liver are reported to occur in up to 5% of the population. Most of them are common and benign, but the possibility of a rarer cystic liver lesion should not be overlooked. They can present with general or specific symptoms. Most are found incidentally on imaging studies. None of the haematological and biochemical parameters were suggestive of liver cyst. We report this case because of its unusual presentation and associated findings. Case scenario: A 66 years old lady presented to general surgery OPD with complaints of mass per abdomen for 3-4 months and pain in abdomen for 2 months. On Examination: A 10X10cm bulge was visible in hypogastric, left hypochondriac and umbilical region. Lump was moving with respiration and was reducing in size on leg raising test. Cystic in consistency, swelling was moving in horizontal direction and dull on percussion. Investigations: CBC, LFT, KFTS, Serum amylase and lipase, chest and abdominal X-ray showed no major abnormality. Upper GI scopy showed bulging posterior wall of stomach suggestive of lump arising behind the stomach. Ultrasound of abdomen was suggestive of two cystic lesions possibly a simple biliary cyst and a pseudocyst of pancreas. Management: Patient underwent exploratory laparotomy with marsupialization and drain placement in both the cysts with left hepatic lobe contained hemorrhagic fluid and the right hepatic lobe contained straw colored fluid. Conclusion: Cystic liver lesions require accurate pre-treatment diagnosis in order to select the appropriate therapy for each patient, as they can represent benign or malignant formations.
Files
IJPCR,Vol15,Issue4,Article74.pdf
Files
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Additional details
Dates
- Accepted
-
2023-04-04
Software
- Repository URL
- https://impactfactor.org/PDF/IJPCR/15/IJPCR,Vol15,Issue4,Article74.pdf
- Development Status
- Active
References
- 1. Swain SK, Balachandar TG, Sahu D, Ramamurthy A, Reddy PK. A Rare SOL of the Liver: Diagnostic and Management Dilemma. Journal of Clinical and Diagnostic Research. 2015 Jun, 9(6): PD03-PD04. 2. Caremani M, Vincenti A, Benci A, Sassoli S, Tacconi D. Ecographic epidemiology of non-parasitic hepatic cysts. J Clin Ultrasound 1993; 21: 115- 118. 3. Hai S, Hirohashi K, Uenishi T, Yamamoto T, Shuto T, Tanaka H, et al. Surgical management of cystic hepatic neoplasms. J Gastroenterol 200 3; 38: 759-764. 4. Bakoyiannis A, Delis S, Triantopoulou C, Dervenis C. Rare cystic liver lesions: A diagnostic and managing challenge. World J Gastroenterol 2013; 19(43): 7603-7619. 5. Bistritz L, Tamboli C, Bigam D, Bain VG. Polycystic liver disease: experience at a teaching hospital. Am J Gastroenterol 2005; 100: 2212-2217. 6. Morgan DE, Lockhart ME, Canon CL, Holcombe MP, Bynon JS. Polycystic liver disease: multimodality imaging for complications and transplantevaluation. Radiograph- ics. 2006; 26: 1655-168. 7. Mortelé KJ, Ros PR. Cystic focal liver lesions in the adult: differential CT and MR imaging features. Radiographics 2001; 21: 895-910. 8. Hogan MC, Masyuk TV, Page L, Holmes DR, Li X, Bergstralh EJ, et al. Somatostatin analog therapy for severe polycystic liver disease: results after 2 years. Nephrol Dial Transplant 2012; 27: 3532-3539. 9. Ozbalci GS, Taurikulu Y, ErelS, Kismet K, Akkus MA. Giant simple hepatic cyst (a case report) and review of literature. Eur J Surg Sci. 2010; 1(2) :53-7. 10. Heap M, Seeger A, Hass CS. Giant solitary hepatic cyst. Liver Int. 2008; 28(6):840. 11. Keerti R, Manickam R, Gowthamen S. Int Surg J. 2021Jun;8(6):1931-1933. 12. Khan A., Tidman D. M. M., Shakir D. S., & Darmal D. I. Breast Cancer in Afghanistan: Issues, Barriers, and Incidence. Journal of Medical Research and Health Sciences, 2022; 5(8): 2125– 2134.