Diagnostic Ultrasound - Abdomen and Pelvis

Hepatic Cyst
Diagnoses: Liver
TERMINOLOGY
• Benign, congenital or developmental, fluid-filled space with
wall derived from biliary endothelium
IMAGING
• Anechoic lesion with posterior acoustic enhancement, welldefined
back wall, and no internal vascularity
• May be unilocular or multilocular with barely perceptible
septations
• Ultrasound
○ Often demonstrates septations to better advantage
than CT or MR
• Current theory
○ True hepatic cysts arise from hamartomatous tissue
• When > 10 in number, consider fibropolycystic diseases
○ Autosomal dominant polycystic liver disease (ADPLD)
○ Autosomal dominant polycystic kidney disease (ADPKD)
○ Biliary hamartomas
KEY FACTS
TOP DIFFERENTIAL DIAGNOSES
• Biliary cystadenoma/cystadenocarcinoma
• Cystic metastases
• Pyogenic abscess
• Echinococcal/hydatid cyst
• Biloma
PATHOLOGY
• Lined by single layer of cuboidal bile duct epithelium
• Surrounding thin rim of fibrous stroma
(Left) Transverse grayscale US
of the liver shows a cyst ſt
adjacent to the portal vein .
The cyst is anechoic with a
well-defined back wall and
posterior acoustic
enhancement . (Right)
Transverse color Doppler US of
the same patient shows no
internal vascularity in the cyst
ſt, confirming the cystic
nature of the lesion.
(Left) Longitudinal color
Doppler US of the liver shows
a cyst ſt with an anechoic
center, well-defined back wall,
and posterior acoustic
enhancement . (Right)
Longitudinal oblique grayscale
US of the liver shows a bilobed
cyst with barely
perceptible septation st and
posterior acoustic
enhancement .
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