Liver Cysts

Overview

Liver cysts (AKA hepatic cysts) are fluid-filled sacs or cavities that can occur in liver tissue. These cysts are usually small, non-cancerous and don’t cause pain or other noticeable symptoms. Other than liver cysts caused by a rare, genetically-inherited condition called Polycystic Liver Disease (PCLD), the root cause of why people develop liver cysts is unknown.

Most liver cysts are found accidentally during imaging scans of the liver for other conditions, and do not require treatment. However, in rare cases, liver cysts can rupture or become infected, which can cause abdominal pain, fever and other issues.

Rare Complications and Conditions

In rare cases, liver cysts can become large enough that they begin to block the flow of blood or bile through the liver, which can prevent the liver from functioning properly. This can result in serious and sometimes painful complications, potentially including edema (swelling in the legs and feet), abdominal pain, jaundice and portal hypertension. Some liver cysts can grow large enough to be seen and felt through the skin. Larger liver cysts are also more likely to rupture, which can lead to infection or hemorrhage.

Another rare condition is Polycystic Liver Disease (PCLD). A genetic disorder that’s estimated to impact less than 1 in 10,000 people, PCLD can lead to a person’s healthy liver tissue being replaced by numerous liver cysts, and can cause liver failure in severe cases. Like other types of liver cysts, PCLD often displays no outward symptoms and is usually discovered accidentally during imaging tests of the abdomen and liver.

Also very rare is biliary cystadenocarcinoma, which are cancerous cystic tumors of the liver. Only a small number of cases have been reported since biliary cystadenocarcinoma was first discovered in 1943.

Why Hoag for Liver Cyst Evaluation and Treatment?

While most liver cysts are small, benign and need no treatment, that’s not always the case. If you’ve recently been diagnosed with liver cysts or Polycystic Liver Disease, Hoag Digestive Health Institute can provide a second opinion you can count on.

Hoag’s unique Liver Program is the most comprehensive in Orange County, offering advanced diagnosis, next-generation imaging options and groundbreaking approaches to treating even rare and challenging diseases of the liver like PCLD.

Hoag’s deep well of liver-specific experience can make a big difference to your diagnosis, treatment and care. So don’t just hope your liver cysts are nothing to worry about. Know for sure, with Hoag. Meet Hoag’s dedicated Liver Program Team.

Symptoms and Causes of Liver Cysts

The vast majority of liver cysts are benign, cause no pain or other symptoms and require no medical treatment. Most people don’t know they have them. However, if liver cysts are very large, they can sometimes cause symptoms and complications. Polycystic Liver Disease (PCLD), a rare genetic condition in which a person’s liver tissue is mostly replaced with numerous cysts, can also cause unique symptoms.

Symptoms of Rare Large Liver Cysts

• Pain and bloating in the upper right abdomen
• A swelling in the abdomen that can be felt through the skin
• Portal hypertension, which is elevated blood pressure within the portal vein that carries blood from the digestive organs to the liver. This increase in pressure can be caused by a blockage in blood flow through the liver, including blockages caused by a very large cyst
• Jaundice
• Edema, which is swelling of the feet and legs

Symptoms of Polycystic Liver Disease (PCLD)

• Abdominal swelling or distension (AKA ascites)
• Shortness of breath
• Acid reflux
• Abdominal pain
• Back pain
• A feeling of abdominal fullness, even if you haven’t eaten a large meal
• Portal hypertension
• Jaundice

Risk Factors

Though polycystic liver disease (PCLD) is caused by a rare genetic disorder that can be passed from parent to child or skip generations, the reason why most people develop liver cysts is unknown.

Diagnosis and Tests

Because liver cysts don’t usually cause pain or other symptoms, most are found accidentally during imaging tests on the abdomen or liver for unrelated issues. Most liver cysts are benign and require no treatment.

If cysts in your liver are abnormal, large or numerous, however, your doctor may order more tests. These may include:

• Imaging tests, including:
  • Ultrasound
  • Computed axial tomography (CT or CAT) scans
• Blood testing, including tests for:
  • Abnormal enzyme levels that can indicate liver damage
  • Increased bilirubin, which is created when your body breaks down hemoglobin and can cause jaundice if levels are too high

Advanced Diagnosis of Liver Conditions at Hoag

As Orange County’s recognized leader in the accurate diagnosis and treatment of conditions involving the liver, the Hoag Digestive Health Institute has a host of advanced diagnostic techniques for those facing serious conditions of the liver, including liver cysts, cirrhosis and chronic liver disease. At Hoag, advanced diagnostics for conditions of the liver include:

• FibroScan®, (AKA transient elastography), which is the first FDA-approved device in the U.S. that provides a painless, non-invasive method of testing for liver scarring without the side effects and complications of a needle biopsy. Learn more about FibroScan®
• Hepatobiliary iminodiacetic acid (HIDA) scanning, which is an advanced imaging technique which utilizes an injected radioactive tracer to diagnose issues with the liver, gallbladder and bile ducts
• Attenuation Imaging (ATI) for Fat Quantification, which is an imaging technique used to quantify fat deposits that may cause inflammation in the liver.
• Magnetic Resonance Cholangiopancreatography (MRCP), which utilizes powerful magnetic fields, radio waves and advanced computing to evaluate the liver and bile ducts for disease, without the use of ionizing radiation
• Magnetic Resonance Elastography (MRE), which is used to detect stiffening of the liver caused by scarring and inflammation. This technology combines MRI imaging with low-frequency vibrations to create a visual map called an elastogram that shows the degree of stiffness of body tissues.
• Magnetic Resonance Multi-Echo Dixon Vibe Liver Iron Quantification, which is a 3D imaging technique used to simultaneously assess fatty liver disease (AKA steatosis) and abnormal iron levels in patients with chronic liver disease.
• Magnetic Resonance Proton Density Fat Fraction (MRI-PDFF), which is an emerging imaging technique that accurately measures the amount of fat in liver tissue by correcting for factors that can degrade or skew magnetic resonance signal intensity

Management and Treatment for Liver Cysts

Most liver cysts are small and benign, and don’t require any medical treatment. However, if liver cysts grow large enough that they begin to inhibit the function of the liver, they may need to be drained and surgically removed.

The treatment options for Polycystic Liver Disease (PCLD) vary from patient to patient. While some patients require no treatment, others may have symptoms or pain that requires intervention. Treatment options for PCLD may include:

• Abdominal percutaneous puncture, in which catheters are inserted into the cysts to drain them, with the cysts then partially refilled with alcohol
• Laparoscopic cyst fenestration, in which openings are cut into the cysts through less-invasive laparoscopic surgery, allowing them to drain into the body where the fluid is absorbed
• Liver resection, in which part of the liver is removed
• Liver transplant, in which the liver is replaced with a liver from a donor

Advanced Treatment for Conditions of the Liver at Hoag

Hoag’s unique, fully-integrated Liver Program is Orange County’s leader in next-generation treatment for conditions involving the liver, including advanced robotic-assisted surgeries and minimally-invasive procedures. Read more about advanced robotic surgery at Hoag.

Explore clinical trials for liver disease and cirrhosis at Hoag.

Prevention

It’s not known why most people develop liver cysts, so there’s currently no known way to reduce your risk of developing the condition.