Successful aspiration and ethanol sclerosis of a large, symptomatic, simple liver cyst: Case presentation and review of the literature

Table 1 Rare complications of simple liver cysts

Obstructive jaundice
Infection
Intracystic haemorrhage
Spontaneous rupture
Inferior vena cava obstruction
Neoplastic transformation
Primary squamous cell carcinoma
Cystadenocarcinoma
Adenosquamous carcinoma
Adenocarcinoma
Hepatocellular carinoma
Cholangiocarcinoma

Table 2 Radiologic features of simple hepatic cysts

Features supporting diagnosisof a simple cyst	Features not supporting diagnosisof a simple cyst
Anechoic lesion	Echoic lesion
Thin wall	Thick wall
Absence of septations	Presence of septations
No peripheral enhancement on CT/MRI	Peripheral enhancement on CT/MRI
Homogeneous appearance	Heterogeneity within the cyst
	Hydatid sand
	Presence of daughter cysts
	Heavy wall calcifications

Table 3 Alternative explanations for symptoms in patients with simple hepatic cysts

Diagnosis
Biliary colic
Gastroesophageal reflux
Peptic ulcer
Non-ulcer dyspepsia
Irritable bowel syndrome
Chronic pancreatitis
Abdominal wall pain syndrome

Table 4 Comparison of treatment options for symptomatic simple liver cysts

Treatment options	Advantages	Disadvantages
Observation alone	- Because most cysts are asymptomatic, intervention is unlikely to be helpful and may be harmful	- Only effective cyst treatment can prove whether symptoms are related to the cyst
US-guided aspiration	- Simple procedure	- High recurrence rate
	- May be used as a diagnostic test to assess whether symptoms are related to the cyst
US-guided aspiration with sclerotherapy	- Relatively non-invasive	- Less effective for uncooperative patients
	- Complications are rare	- Can not be performed if cyst communicates with biliary tree
	- Effective
	- Possible in poor surgical candidates
Laparoscopic unroofing	- Technically feasible and effective in > 80% cases	- More invasive
	- Improved results with extensive fenestration and argon beam coagulation or electrocoagulation	- Morbidity in up to 25%
	- Low recurrence rate (0%-20%)	- Less effective for cysts which are superior, posterior, or deep within hepatic parenchyma
	- Visualization of cyst interior (exclude other diagnoses)	- Less effective if prior surgery has been attempted
Laparotomy (resection, fenestration, or excision)	- Effective	- Most invasive
	- Allows treatment of laparoscopically inaccessible cysts	- Larger scars
	- Useful for cysts with complications	- Longer hospital stays compare to laparoscopy
	- May perform cystojejunostomy at time of laparotomy for cysts with biliary communication	- Significant post-surgical morbidity