What are liver cysts?
A simple, or non-parasitic, cyst is the most common: a single cavity with transparent contents and a thin wall; it usually does not grow or grows very slowly. Polycystic liver disease is an inherited condition with many cysts, often in combination with polycystic kidney disease. An hydatid cyst is caused by a parasite and has a characteristic structure with a dense shell and sometimes daughter cavities; it is found in regions where livestock farming is common. There are also post-traumatic and inflammatory cavities, as well as rare cystic tumors, which require special attention and separate tactics.
- Simple nonparasitic cyst
- Polycystic liver disease
- Hydatid cyst
- Post-traumatic cavity
- Liver abscess
- Rare cystic tumors
Symptoms
Small cysts do not give any complaints and do not affect the functioning of the liver: liver tests with them remain normal. Symptoms appear when the formation reaches several centimeters and begins to put pressure on neighboring structures. Then there is heaviness and dull pain in the right hypochondrium, a feeling of rapid satiety, nausea, and sometimes shortness of breath with very large cysts. Complications are rare, but possible: hemorrhage into the cavity, suppuration with fever and chills, rupture, and if the bile ducts are compressed, jaundice. With echinococcosis, rupture is also dangerous due to a severe allergic reaction.
- Most often asymptomatic
- Heaviness and dull pain on the right
- Rapid satiety and nausea
- Shortness of breath with very large cysts
- Temperature and chills during suppuration
- Jaundice due to compression of the bile ducts
How are hydatid cysts distinguished?
This is a key question, because the tactics are fundamentally different. A simple cyst has a thin wall and homogeneous content, an echinococcal cyst has a dense capsule, sometimes septa, daughter blisters and areas of calcification. Serological blood tests for antibodies to echinococcus help, although they are not always positive. An epidemiological history is important: living in rural areas, contact with dogs, caring for livestock. Puncture of a cyst suspected of echinococcus without preparation is strictly unacceptable: spilling the contents can cause a severe allergic reaction and spread of the parasite.
- Dense capsule and daughter blisters on ultrasound
- Areas of wall calcification
- Serological tests for echinococcus
- History of contact with dogs and livestock
- Prohibition on puncture without special preparation
Survey
The primary and main method is liver ultrasound: it determines the size, number, location and structure of formations. If the picture is typical of a simple cyst, and there are no complaints, a control ultrasound after 6–12 months is usually sufficient, and then less frequently. If there is any doubt, large size, septa, dense contents, or planning surgery, computed tomography or magnetic resonance imaging with contrast is performed. Additionally, liver tests and a general blood test are assessed, and if a parasitic nature is suspected, specific antibodies are assessed. Magnetic resonance cholangiography helps evaluate the connection of the cyst with the bile ducts.
- Ultrasound of the liver with a description of the structure
- Control ultrasound in dynamics
- Computed tomography or magnetic resonance imaging with contrast
- Liver tests and complete blood count
- Serology for echinococcus
- Magnetic resonance cholangiography if necessary
Treatment
Simple cysts without symptoms are not treated, they are observed: no drugs or herbs resolve the cavity. If the cyst is large and causes complaints, an operation is performed - most often laparoscopic excision of the wall, which gives a lasting result; isolated puncture with fluid drainage usually leads to re-accumulation. In polycystic disease, tactics depend on the extent of the lesion and liver function. Echinococcal cysts require a special approach: antiparasitic therapy and surgical removal in compliance with measures to prevent contamination. Cystic tumors are removed completely, as with cancer.
- Observation for asymptomatic simple cysts
- Laparoscopic excision of the wall of a large cyst
- Puncture as a temporary measure in case of high operational risk
- Antiparasitic drugs and surgery for echinococcosis
- Radical removal of cystic tumors
- Refusal of self-medication and attempts to “dissolve” the cyst