Evaluation of hepatic cystic lesions

Table 1 Differential diagnosis of cystic lesions in the liver

Monocytic disease

Simple cyst

Echinococcosis

Cystic echinococcosis

Alveolar echinococcosis

Cystadenoma

Cystadenocarcinoma

Polycystic disease

Autosomal dominant polycystic kidney disease

Autosomal dominant polycystic liver disease

Table 2 Ultrasonography features for the diagnosis of monocytic diseases of the liver

	Simple cyst	Cystic echinococcosis	Alveolar echinococcosis	Cystadenoma and cystadenocarcinoma
Border	Sharp and smooth	Laminated	Irregular	Irregular
Shape	Spherical or oval	Round or oval	Irregular	Round or oval
Echo pattern	Anechoic1	Anechoic or atypical2	Hyperechogenic outer ring and hypoechogenic centre	Hypoechogenic with hyperechogenic septations
Appearance	No septa	Multiseptated	Multivesicular	Septated and/or solid structures (papillary projections)
Wall	Strong posterior wall echoes			Wall enhancement
Posterior acoustic feature	Relative3 accentuation of echoes		Dorsal shadowing (calcified areas)	Dorsal shadowing (calcified areas)

¹Fluid-filled cavity;

²Snowflake-like inclusions or floating laminated membranes;

³Compared to echoes at a similar depth transmitted through normal adjacent hepatic tissue.

Table 3 Ultrasonography criteria for the diagnosis of autosomal dominant polycystic kidney disease

Family history positive1
Unknown genotype
	Age (yr)
	≥ 15 and ≤ 39	≥ 3 unilateral renal cysts
	≥ 40 and ≤ 59	≥ 2 bilateral renal cysts
	≥ 60	≥ 4 bilateral renal cysts
Family history negative
	> 10 bilateral renal cysts, with the exclusion of renal or extra-renal disease causing renal cysts

¹Exclude autosomal dominant polycystic kidney disease when < 2 unilateral renal cysts and ≥ 40 years of age.