case_images: PMC10807977_01
case_images: Ultrasonography revealed a giant cyst in the left lobe of the liver (a). The dimensions were 76 x 81 mm. No septa or mural nodules were observed. Contrast-enhanced computed tomography (CT) revealed that the liver cyst had replaced the left lobe. The left branch of the portal vein surrounded the hepatic side of the liver cyst (b) (arrowheads). Magnetic resonance cholangiopancreatography showed that the liver cyst had no communication with the bile duct. There were no neoplastic findings indicating a simple liver cyst (c). On the CT scan after the test puncture (d), the gastric antrum (arrow) migrated to the ventral side of the liver cyst (arrowheads).
case_images: CRIGM2024-6942345.001.jpg
case_images: PMC10807977_01_CRIGM2024-6942345.001.jpg
case_images: fig1
case_images: Abdominal ultrasound (US) revealed several liver cysts, the largest of which was 76 x 81 mm in the left lobe, and a homogeneous anechoic area without septum or mural nodules (Figure 1(a)). In addition, the left branch of the portal vein was shifted to the right side of the liver cyst (Figure 1(b)). Contrast-enhanced CT and magnetic resonance cholangiopancreatography did not show any communication between the bile ducts and the cyst or any findings suggestive of the presence of a tumor (Figures 1(b) and 1(c)). Puncture through the liver was not possible as the portal vein was on the puncture line and could not be avoided (Figure 1(b)). A CT scan after the puncture revealed that the cyst shrank and the gastric antrum migrated to the ventral side of the liver cyst, which was considered to be the reason for the puncture needle tip's invisibility (Figure 1(d)).
case_images: The liver cyst was visualized from the anterior wall of the gastric body using a therapeutic linear echoendoscope and punctured with a 19-gauge needle (a). Two guidewires were inserted into the liver cyst through a cannula (b). An internal 7-Fr loop diameter 10 cm double pigtail catheter and an external 6-Fr nasocystic drainage catheter were inserted into the liver cyst ((c) endoscopy; (d) X-ray).
case_images: CRIGM2024-6942345.002.jpg
case_images: PMC10807977_01_CRIGM2024-6942345.002.jpg
case_images: fig2
case_images: Tokyo, Japan) and punctured with a 19-gauge needle (EZ Shot 3 Plus, Olympus) (Figure 2(a)). The punctured fluid was slightly turbid and bloody suggesting liver cyst infection. ENBD Catheter, Boston Scientific, Massachusetts, USA) (Figures 2(c) and 2(d)). Enterococcus faecium was detected in the aspirated fluid culture.
case_images: Computed tomography (CT) scan after the first sclerotherapy showing the shrunken liver cyst (a) (arrowheads). We exchanged the external tube for an internal stent (two internal stent insertions) ((b) endoscopy; (c) X-ray). A CT scan showed no recurrence of the liver cyst for 6 months after stent removal (d).
case_images: CRIGM2024-6942345.003.jpg
case_images: PMC10807977_01_CRIGM2024-6942345.003.jpg
case_images: fig3
case_images: As a result, the liver cyst gradually shrank (Figure 3(a)). We exchanged the nasocystic tube for an internal stent, and the patient was discharged 31 days after the initial treatment with two internal stent placements (Figures 3(b) and 3(c)). The stents were removed 5 months after the initial treatment, and a CT scan showed no recurrence of the liver cyst for 6 months after stent removal (Figure 3(d)).