Benign hemorrhagic hepatic cyst.

HISTORY: 73-year-old female with right upper quadrant pain.

 

FINDINGS: Image 1 is a color Doppler sonogram of the right lobe of the liver demonstrating a large complex cystic lesion that contains tissue along the inner aspect of the cyst wall.  Notice that the "internal

tissue" is entirely avascular with color Doppler sonography.

 

Noncontrast CT scans demonstrate a large nondescript cystic lesion.

DIAGNOSIS: Benign hemorrhagic hepatic cyst.

DISCUSSION: The differential diagnosis of this complex cystic lesion includes abscess, hematoma, biloma, cystic neoplasm and, as in this

case, a hemorrhagic cyst.  Parasitic cysts may also be included in the

differential diagnosis.  However, there are often more specific

features, such as daughter cysts or calcification of the cyst wall, that

are not present in this case.  Amoebic abscesses may be perfectly round or oval in configuration and demonstrate no evidence of calcification.

The failure of color Doppler to show any intrinsic vascularity within

the mural tissue on ultrasound was an important observation.  At

pathologic examination this proved to be an area of clot within the

hemorrhagic cyst.  Clot, of course, would be avascular unlike the mural nodules of malignant lesions such as biliary cyst adenocarcinoma or

metastatic ovarian carcinoma.