Large intrahepatic cysts and pseudocysts: Pitfalls in diagnosis and treatment

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The records of forty-seven patients with large intrahepatic cysts or pseudocysts were analyzed. Thirty-one of the cysts were developmental and sixteen were acquired. Patients with developmental cysts and those with neoplastic cysts had similar features, including an absence of constitutional illness, but patients with infective pseudocysts generally had features of systemic disease and often had hematologic abnormalities. Sonography indicated the cystic nature of the lesions, but operation was usually necessary to establish a precise diagnosis. Four of the solitary giant cysts were successfully treated by subtotal excision—a less extensive procedure than hepatic resection or total excision of the cyst. Recurrences were common after lesser procedures. The nature of two malignant cysts was not recognized at operation, and cysts with macroscopic features of neoplasia should be treated by hepatic resection even when frozen section biopsy fails to support such a diagnosis. Pyogenic pseudocysts were treated adequately by drainage, but echinococcal cysts required injection with hypertonic saline or Formalin and partial or complete excision for cure. Traumatic pseudocysts healed only when bleeding or bile leakage into the cyst cavity was controlled.