Since the widespread application of ultrasound imaging, asymptomatic congenital liver cysts have become very common, often multiple and more frequent in middle-aged women, frequently accompanied by polycystic kidneys. The walls of congenital liver cysts are composed of epithelial cells, and the cystic fluid is usually colorless or transparent, though it may appear brown if bleeding occurs. Multiple cysts are often small and distributed throughout various parts of the liver.

bubble_chart Clinical Manifestations

Congenital small liver cysts are often asymptomatic and usually only cause symptoms when they grow to a considerable size, including upper abdominal distension and fullness, pain, abdominal masses, and hepatomegaly. If infection occurs, inflammatory symptoms such as fever and pain may appear.

bubble_chart Auxiliary Examination

Ultrasonography is the most diagnostically valuable, showing typical fluid-filled lesions with thin walls; computed tomography (CT) also reveals fluid-filled lesions without enhancement filling.

bubble_chart Diagnosis

Most cases have no background of hepatitis or cirrhosis; AFP is negative, and liver function is mostly normal. A definitive diagnosis can usually be made with careful ultrasound imaging.

bubble_chart Treatment Measures

Patients without obvious symptoms or liver function impairment may not require treatment. However, if symptoms are intolerable or liver function is affected, surgical intervention can be considered. Partial cyst wall resection, also known as "fenestration," is commonly performed. For cysts with clear fluid and no bile, the superficial portion of the cyst wall can be excised while preserving the cyst wall within the liver parenchyma, allowing the cyst fluid to drain into the abdominal cavity and be absorbed by the peritoneum. The same approach can be applied to polycystic liver disease. If the cyst communicates with the bile ducts, efforts should be made to seal the bile duct opening within the cyst. If necessary, internal drainage may be performed. For infected cysts, drainage and catheter suction can be employed. Recent reports have described percutaneous aspiration of cyst fluid followed by injection of absolute alcohol to destroy the cyst wall endothelium.

① Hepatic hydatid cyst: Often has a history of living in endemic areas, with a positive hydatid skin test. ② Liver abscess: Presents with inflammatory symptoms, often has a history of suppurative disease or dysentery. Ultrasound imaging shows no clear thin wall, with inflammatory changes around the liquid-occupied area. ③ Central liquefaction of a large tumor: Ultrasound reveals both liquid and solid components within the lesion.