This axial CT scan of the abdomen shows a large liver cyst with displacement of the normal liver.

Intraoperatively 4 liters of cyst fluid was collected. This image demonstrates the thin nature of the cyst wall.

Another view of the cyst wall intraoperatively.

Intraoperatively, the liver demonstrated mild to moderate cirrhosis.

Hepatic cysts, also known as "simple cysts", are solitary nonparasitic cysts of the liver. Other cystic conditions that affect the liver are polycystic liver disease, parasitic or hydatid liver cysts, cystic tumors, and hepatic abscesses.

The most common extra-hepatic manifestation of autosomal dominant polycystic kidney disease (ADPKD). By age 50, it is estimated that 70-80% of patients with ADPKD will have hepatic cysts. In women, these cysts can undergo massive enlargement.

It's estimated that about 5% of the population harbor liver cysts and less than 20% of these individuals will ever be symptomatic. Most asymptomatic cysts are found incidentally on imaging studies or at laparotomy.

Simple liver cysts may have an embryonic origin and are lined with biliarly epithelium and are thought to result from progressive dilation of biliary microhamartomas. These may be leftover populations of hepatic tissue that failed to find a connection to the liver propper in-utero. The cyst wall epithelium continually secretes plasma-like fluid, and for this reason, simple aspiration is not a viable long-term treatment option.

Patients with very large simple cysts may experience dull upper abdominal pain, bloating, early satiety, and very rarely an upper abdominal mass. When simple cysts rupture, a secondary infection may occur which mimics hepatic abscess.

Most individuals with simple hepatic cysts are asymptomatic will require no treatment. As previously mentioned, percutaneous aspiration is not an effective long-term treatment, although some authors have experimented with sclerosis for smaller cysts combined with aspiration.

When simple cysts are symptomatic, treatment involves cyst evacuation and marsupialization of the the cyst into the abdominal cavity. The fluid secreted by the residual cyst epithelium is resorbed by the peritoneum without any consequence. Typically this procedure is done laporoscopically.

Several small series of patients undergoing laparoscopic marsupialization of simple hepatic cysts have reported cure rates of 90% or higher.