Radiology Teaching Files > Case 202150

never visited POLYCYSTIC LIVER
Contributed by: Virginia Mason Medical Center, Virginia Mason Medical Center, Washington, USA.
Patient: 65 year old female
History: 65-year-old woman with recent CVA, found to have dramatic epigastric distention and episodic hypoxemia.

Fig. 1: Large liver cysts, compressing IVC

Fig. 2: Liver displaced to the left

Fig. 3: Elevated Right Diaphragm, w/ hypoxemia

CT Abd with contrast: Multiple cysts replacing the right superior lobe of the liver, largest measuring 21.2cm near the hilum. Also note extrinsic compression of the IVC and displacement of liver to the left by the cysts.

CT Chest Scout: Significant elevation of the right hemidiaphragm.

IR: The largest liver cyst was drained under ultrasound guidance. Four (4)Liters of brown, non-turbid fluid were released at the time of procedure, and two (2) more Liters were drained slowly over the next two days.

Diagnosis: Polycystic Liver disease in the setting of mild polycystic kidney disease

Incidence of liver cysts in patients with polycystic kidney disease increases with age. Among patients over 60, more than 40% have cysts in the liver. These patients more commonly have advanced renal disease.

Liver cysts in the setting of polycystic kidney disease occur equally in men and women. However, massive cysts occur almost exclusively in women and especially in those who have had several pregnancies. Thus, their growth may be sensitive to female hormones.

Most patients have no symptoms and retain good liver function. However, some develop pain, requiring cyst decompression. Others develop cystic infection, hemorrhage, or rupture. H2-blockers or somatostatin analogue have been used in treating symptomatic patients, but with limited data so far.

This patient had few small cysts in the kidneys and did not have any signs of renal or hepatic impairment. She subsequently had 2 more of her largest cysts drained and sclerosed by IR.

References: Bennet W., Rose B., "Extrarenal Manifestations of Polycystic Kidney Disease". Up to Date Online, 11.3 version.
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Additional Details:

Case Number: 202150Last Updated: 11-10-2003
Anatomy: Gastrointestinal (GI)   Pathology: Benign Mass, Cyst
Modality: CT, GIExam Date: 08-20-2003Access Level: Readable by all users
Keywords: polycystic liver

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