Rapid regrowth of a large hepatic cyst following spontaneous rupture

Akiko Shibuya,Junko Yamaoka,Manabu Okajima,Tomoki Nakajima,Toshiaki Nakashima,Yoshito Itoh

doi:10.5348/ijcri-2014-02-466-cr-18

Abstract

Introduction: spontaneous rupture of a simple hepatic cyst is rare, and the clinical course after rupture is not fully known. We report a case of a huge hepatic cyst which rapidly regrew after spontaneous rupture. case report: A 74-yearold male underwent further examination and follow-up of a huge hepatic cyst which was first detected at annual health check. On his first visit, the cyst was 10×9 cm in size. During the first 7 years of follow-up, the cyst gradually grew to 18×14 cm. Eight years after his first visit, ultrasonography showed that the huge hepatic cyst was without intracystic echogenic content. However, nine days after that, a computed tomography (ct) scan revealed that the cyst had nearly disappeared with remnant minimal cystic fluid and ascites although the patient was asymptomatic. subsequently, within one month, the patient complained of back pain, and another ct scan showed that the cyst rapidly regrew to 13×10 cm in size. the cyst gradually regressed after sequential intracystic injection of absolute ethanol and minocycline. conclusion: the rapid disappearance of the cyst was considered to be due to intraperitoneal

Highlights

Spontaneous rupture of a simple hepatic cyst is rare, and the clinical course after rupture is not fully known
We report a case of a huge hepatic cyst which rapidly regrew after spontaneous rupture
In some cases of huge hepatic cyst, rupture may be dismissed because it can be asymptomatic and the cystic fluid may have possibly already accumulated by the time symptoms appear

Summary

Introduction

Simple hepatic cysts are considered to be congenital. They are generally stable in size over time and require no treatment [1]. We report a case of a huge hepatic cyst which rapidly regrew after spontaneous rupture. Magnetic resonance imaging (MRI) scan suggested that the lesion was a simple cyst of 10×9 cm in size and had no sign of infection, hemorrhage or malignancy (Figure 1). A CT scan performed on June 19, 2009 revealed that the huge cyst had nearly disappeared during this nine-day period, and only a small amount of cystic fluid remained (Figure 4A–B). After complete aspiration of the cystic fluid, we intracystically injected contrast medium and ensured there was no communication with the biliary tree or extravasation into the peritoneal cavity. Because the cyst remained for 2 months, 100 mL of absolute ethanol followed by 200 mg of minocycline hydrochloride dissolved in 20 mL of saline were sequentially injected with an interval of one week. The liver function tests were within normal range and stable throughout this clinical course

Findings

DISCUSSION

CONCLUSION