Definition — Hepatic Simple Cyst: A benign, developmental, non-parasitic cystic lesion of the liver lined by cuboidal epithelium, usually containing clear serous fluid. Sonographically, it appears as a well-defined, anechoic lesion with thin, imperceptible walls, posterior acoustic enhancement, and without internal septations, solid components, or vascularity. Typically asymptomatic and incidentally detected, but large cysts may cause mass effect symptoms. Differentiation from hydatid cyst or cystic neoplasm is important in relevant clinical contexts.
Sonographic features — Hepatic Simple Cyst:
- Size & shape: Usually round or ovoid, variable in size (few mm to several cm), with smooth and well-defined margins.
- Wall characteristics: Thin, imperceptible wall without irregularity, calcification, or nodularity.
- Internal contents: Anechoic (completely echo-free) fluid content without septations or internal echoes.
- Posterior acoustic features: Prominent posterior acoustic enhancement (increased through-transmission).
- Vascularity: No internal vascularity on color Doppler imaging.
- Distribution: May occur singly or as multiple simple cysts; usually asymptomatic and found incidentally.
Case Study — 1: Hepatic Simple Cyst:
Mrs. S., 54 years old, female, presented for routine health check-up with nonspecific abdominal bloating. She had no history of jaundice, fever, weight loss, or liver disease. No history of alcohol intake or prior abdominal surgery. No relevant family history.
Clinical Examination:
Patient afebrile, no pallor or icterus. Abdomen soft, non-tender, no palpable hepatomegaly, no ascites. No stigmata of chronic liver disease. General and systemic examination unremarkable.
Laboratory Findings:
CBC: Hb 12.8 g/dL, WBC 6,400/µL, Platelets 220,000/µL.
LFT: Bilirubin 0.8 mg/dL, AST 28 U/L, ALT 32 U/L, ALP 86 U/L, Albumin 4.2 g/dL.
INR 1.0. Serum AFP within normal limits. Viral markers (HBsAg, anti-HCV) negative.
Ultrasound Examination:
Transabdominal ultrasound performed using 3.5–5 MHz convex probe.
- A well-defined anechoic round cyst in the right hepatic lobe (segment V/VII) measuring 67 x 46 mm.
- Imperceptible thin wall, no septations or mural nodules.
- Prominent posterior acoustic enhancement.
- No internal vascularity on color Doppler.
Ultrasound Report — Hepatic Simple Cyst:
A solitary, well-circumscribed, thin-walled anechoic lesion with posterior acoustic enhancement, measuring 67 x 46 mm in the righ hepatic lobe, without septations, solid component, or vascularity. No intrahepatic biliary dilatation or additional focal hepatic lesion seen. Findings consistent with a Hepatic Simple Cyst.
Conclusion:
Benign hepatic simple cyst. No features to suggest parasitic, neoplastic, or complicated cyst.
Recommendation:
No active intervention required. Symptomatic management if bloating persists. Follow-up ultrasound only if lesion enlarges or symptoms develop.
Causes / Etiology — Hepatic Simple Cyst:
- Congenital biliary microhamartomas with cystic dilatation.
- Embryological maldevelopment of intrahepatic bile ducts.
- Non-parasitic, non-neoplastic origin.
Symptoms / Clinical Features — Hepatic Simple Cyst:
- Most are asymptomatic and discovered incidentally.
- Large cysts may cause abdominal fullness, discomfort, or early satiety.
- Rarely, pain due to cyst hemorrhage, rupture, or infection.
Diagnostic Strategy — Hepatic Simple Cyst:
- Ultrasound: Anechoic, thin-walled, well-defined, posterior enhancement, no septa or nodules.
- CT/MRI: Simple fluid attenuation/signal, no enhancement.
- Differentiation: Important to exclude hydatid cyst, cystic neoplasm, or abscess in symptomatic or atypical cases.
Risk Factors — Hepatic Simple Cyst:
- Female sex (2–3 times more common).
- Age > 40 years.
- Polycystic liver disease (rare familial association).
Declaration:
I, R. K. Mouj, hereby declare that the material presented in this document titled "Hepatic Simple Cyst: Definition, Sonographic Features, Case Studies, and Risk Assessment" has been prepared and compiled by me for educational purposes only. It is intended for learning, training, and academic reference. Sources and references have been acknowledged where appropriate.
Ethics / Patient Data Statement: Any patient images, case material, or ultrasound examples included here are for academic use only, anonymised, and used with ethical consideration.
Author: ____________________
Name: R. K. Mouj [Radio-imaging Technologist]
Supervisor / Guide: Department radiologist
Department: Radiology
Institution: ____________________
Date: 16-09-2025
"Every cyst tells a story — knowing the benign from the sinister is the art of ultrasound."
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