Focal Liver Lesions that can be safely managed and monitored at the primary care setting (Part 4)
Simple hepatic cysts are very common, its prevalence had been reported to be as high as 15-18% in CT series. (10) On USG they appear as anechoic, homogeneous fluid filled lesion with smooth margin. CT would likewise show well-demarcated, water- attenuated smooth walled lesions without contrast enhancement. Most simple hepatic cysts are asymptomatic, incidental findings. However, the larger ones could cause pain or compressive symptoms—these can be treated surgically or by aspiration followed by sclerotherapy.
With atypical findings, clinicians should be alerted about possibility of
1) biliary cystadenomas (irregular walls and internal septation on USG; heterogeneous septations, irregular papillary growths and thickened cyst walls on CT) as malignant transformation was possible and they must be surgically excised.
2) polycystic liver disease (similar features of cysts on USG and CT but extensive in number)—this entity tends to be much more symptomatic and may even be associated with polycystic kidney disease. Early referral to surgeon or transplantation team should be considered.
3) hydatid cyst (thick calcified wall on USG with hyper- or hypoechoic content and presence of daughter cysts; hypodense lesion with hypervascular pericyst wall and endocyst wall on CT)—caused by Echinococcus granulosus infection, it is more common in sheep grazing areas and not commonly seen in our locality. However it is worth considering in foreign patients and they should be referred for treatment.
Detection of FLLs had become more and more often and the trend will likely continue in the future. Some of them can be safely managed at the primary care settings. Family physicians are encouraged to acquaint with the imaging findings of different lesions and identify the high risk patients, in order to safely manage some benign conditions at the primary care setting.
The above information is provided by Dr Chik Hsia Ying, Barbara