Diagnostic Ultrasound - Abdomen and Pelvis

Ciliated Hepatic Foregut Cyst
Diagnoses: Liver
TERMINOLOGY
• Rare foregut developmental malformation in liver
IMAGING
• US
○ Single hypoechoic unilocular cyst
○ May have variable internal echoes
• CT
○ NECT: Hypoattenuating; sometimes iso- or
hyperattenuating
○ CECT: No contrast enhancement
• MR
○ T1WI:Hyperintense due to mucin content
○ Brightly hyperintense on T2WI
TOP DIFFERENTIAL DIAGNOSES
• Complicated hepatic cyst
• Biliary cystadenoma/cystadenocarcinoma
• Biloma
KEY FACTS
• Hematoma
PATHOLOGY
• Detached outpouching of hepatic diverticulum or adjacent
enteric foregut
CLINICAL ISSUES
• Mostlyasymptomatic and incidentally found by imaging
• Clinical course usually benign
• 3% risk of malignant transformation: Squamous cell
carcinoma, usually in setting of large cyst
• Treatment: Surgical excision or enucleation irrespective of
size to eliminate subsequent cancer risk
DIAGNOSTIC CHECKLIST
• Rule out other cystic lesions and solid hypovascular
tumorous lesions in liver
• Single unilocular cystic lesion in or close to hepatic segment
IV in subcapsular portion with variable internal contents
(Left) Oblique abdominal
grayscale ultrasound in a
patient with a ciliated hepatic
foregut cyst shows a welldefined,
ovoid, subcapsular
cystic mass ſt in segment IV
of the liver st. Internal
content of the cystic lesion is
relatively homogeneous.
Minimal posterior acoustic
enhancement is visible.
(Right) Color Doppler
ultrasound in the same patient
shows no detectable internal
color flow within the cystic
mass ſt.
(Left) Transverse abdominal
grayscale ultrasound in a
patient with ciliated hepatic
foregut cyst shows an ovoid
subcapsular cystic mass in
segment IV of the liver ſt. The
lesion contains numerous tiny
echogenic foci st consistent
with mucinous debris.
(Courtesy R. Baxter, MD.)
(Right) Color Doppler
ultrasound in the same patient
shows no detectable color
flow within the cystic mass ſt.
(Courtesy R. Baxter, MD.)
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