Recurrent giant simple hepatic cyst: an unusual cause of dyspnoea in an elderly man. Issue 2 (4th February 2021)

• Record Type: Journal Article
• Authors: Bag, Nerbadyswari Deep; Mohakud, Sudipta; Naik, Suprava; Shri, Aishvarya
• Is Part Of: BMJ case reports. Volume 14:Issue 2(2021)
• Publication Date: 2021-02-04
• Subjects: radiology (diagnostics) -- radiology -- ultrasonography -- interventional radiology; Medicine -- Case studies -- Periodicals; 610.5
• DOI: 10.1136/bcr-2020-238882
• Languages: English
• ISSNs: 1757-790X

Abstract

Abstract : An 88-year-old man presented to the emergency department with exertional dyspnoea and orthopnoea. Clinical examination revealed mildly raised jugular venous pressure, increased respiratory rate, palpable non-tender hepatomegaly and reduced right basal breath sounds. Ultrasonography showed a large right simple hepatic cyst, multiple small left hepatic and renal cysts. A non-contrast CT scan revealed a large, right hepatic thin-walled cyst of volume 4.2 L, exhibiting few thin septae and tiny nodular mural calcifications. Pressure effects were elevated right haemidiaphragm, right atrial compression and adjacent atelectasis. He had a similar episode 2 years ago, treated by percutaneous needle aspiration. Giant simple hepatic cysts are rare and present when symptomatic due to pain, mass effect on adjacent organs, infection or rupture. These may unusually cause dyspnoea or orthopnoea by compressing cardiac chambers. Simple aspiration has a high recurrence rate. Percutaneous sclerosant injection, laparoscopic deroofing and cystectomy are better treatment modalities.