EURORAD ESR

Case 10937

Varied complications of multicystic liver

Author(s)
Tonolini Massimo

"Luigi Sacco" University Hospital,
Radiology Department;
Via G.B. Grassi 74
20157 Milan, Italy;
Email:mtonolini@sirm.org
 
Patient
female, 88 year(s)
 
 
  • Figure 1
    Initial contrast-enhanced CT including multiplanar image reformations
     

    Two months earlier, contrast-enhanced axial (a..d, in cranio-caudal order), coronal (e) and sagittal (f) reformatted images showed several, mostly large-sized simple liver cysts with fluid attenuation.

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Dilation; Special Focus: Cysts;

    Moderate dilatation of some intrahepatic bile ducts (arrowheads) was noted, caused by compression from one of the largest cysts. The inferior vena cava is patent and not significantly compressed.

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Cysts;

    Several, mostly large-sized simple liver cysts with fluid attenuation are present throughout the liver. The inferior vena cava is patent and not significantly compressed. No polycystic kidney changes were noted.

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Cysts;

    Coronal (d) and sagittal (f) reformatted images effectively show occupation of the liver by several, confluent giant hepatic cysts, causing marked right diaphragm elevation.

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Cysts;

    Coronal (d) and sagittal (f) reformatted images effectively show occupation of the liver by several, confluent giant hepatic cysts, causing marked right diaphragm elevation. Note moderate dilatation of intrahepatic...

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Cysts;

    Unenhanced (f,g), arterial-dominant (h) and venous (i) phase images show both kidneys with normal size, parenchymal thickness and contrast enhancement for age, without cysts and hydronephrosis.

     
    Area of Interest: Kidney; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Cysts;

    Unenhanced (f,g), arterial-dominant (h) and venous (i) phase images show both kidneys with normal size, parenchymal thickness and contrast enhancement for age, without cysts and hydronephrosis.

     
    Area of Interest: Kidney; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Cysts;

    Unenhanced (f,g), arterial-dominant (h) and venous (i) phase images show both kidneys with normal size, parenchymal thickness and contrast enhancement for age, without cysts and hydronephrosis.

     
    Area of Interest: Kidney; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Cysts;

    Unenhanced (f,g), arterial-dominant (h) and venous (i) phase images show both kidneys with normal size, parenchymal thickness and contrast enhancement for age, without cysts and hydronephrosis.

     
    Area of Interest: Kidney; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Cysts;
     
     
  • Figure 2
    Repeat contrast-enhanced CT
     

    Currently, axial images (a..c) show enlargement of the dominant simple hepatic cyst (compared to Fig.1b) corresponding to physical finding, and increased dilatation of intrahepatic bile ducts (arrowheads).

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Cysts;

    The enlarged dominant simple hepatic cyst causes increased dilatation of intrahepatic bile ducts (arrowheads), and compression of the inferior vena cava.

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Cysts;

    The enlarged dominant simple hepatic cyst causes increased dilatation of intrahepatic bile ducts (arrowheads), and compression of the inferior vena cava.

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Cysts;

    Coronal reformatted images (d,e) better depict increased dilatation of intrahepatic bile ducts (arrowheads), caused by compression of the dominant cyst on the liver hilum.

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Cysts;

    Coronal reformatted images (d,e) better depict increased dilatation of intrahepatic bile ducts (arrowheads), caused by compression of the dominant cyst on the liver hilum.

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Cysts;
     
     
  • Figure 3
    Percutaneous ultrasound-guided drainage & Post-drainage follow-up contrast-enhanced CT
     

    Ultrasound-guided percutaneous puncture (a) and drainage positioning (arrowhead in b) was performed on the dominant hepatic cyst, yielding sterile serous fluid.

     
    Area of Interest: Liver; Imaging Technique: Percutaneous; Procedure: Puncture; Special Focus: Cysts;

    Ultrasound-guided percutaneous puncture (a) and drainage positioning (arrowhead in b) was performed on the dominant hepatic cyst, yielding sterile serous fluid.

     
    Area of Interest: Liver; Imaging Technique: Percutaneous; Procedure: Puncture; Special Focus: Cysts;

    Days later, post-procedural follow-up contrast-enhanced CT showed dominant hepatic cyst partially collapsed with drainage tube in place (arrowhead).

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Puncture; Special Focus: Cysts;
     
     
  • Figure 4
    Urgent unenhanced CT at acute presentation
     

    Six months after hospital discharge, urgent unenhanced acquisition because of impaired renal function showed enlarged dominant hepatic cyst, with hyperattenuating material (*) consistent of fresh blood in its...

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Haemorrhage;

    Urgent unenhanced acquisition due to impaired renal function showed enlarged dominant hepatic cyst, filled by hyperattenuating material (*) consistent of fresh blood. Note moderate non-haemorrhagic peritoneal effusion.

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Haemorrhage;

    Coronal reformatted unenhanced images (c, detail in d) confirm enlarged dominant hepatic cyst, with hyperattenuating material (*) consistent with fresh blood in its dependent part. Note moderate non-haemorrhagic...

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Haemorrhage;

    Coronal reformatted unenhanced images (c, detail in d) confirm enlarged dominant hepatic cyst, with hyperattenuating material (*) consistent with fresh blood in its dependent part. Note moderate non-haemorrhagic...

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Haemorrhage;
     
     
  • Figure 5
    Repeat contrast-enhanced CT 24 hours later
     

    With improved renal function, 24 hours later contrast-enhanced CT including arterial (a,b) and venous (c..e)-phase acquisitions shows stable hemorrhagic (*) giant liver cyst, persistent non-haemorrhagic peritoneal...

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Haemorrhage;

    In the arterial phase acquisition, stable haemorrhagic (*) giant liver cyst is seen without appreciable contrast extravasation indicating active bleeding.

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Haemorrhage;

    Axial (c) and coronal (d, detail in e) venous phase images show giant haemorrhagic (*) hepatic cyst with small foci (arrows) of contrast extravasation indicating active bleeding. Persistent non-haemorrhagic peritoneal...

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Haemorrhage;

    Axial (c) and coronal (d, detail in e) venous phase images show giant haemorrhagic (*) hepatic cyst with small foci (arrows) of contrast extravasation indicating active bleeding. Persistent non-haemorrhagic peritoneal...

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Haemorrhage;

    Axial (c) and coronal (d, detail in e) venous phase images show giant haemorrhagic (*) hepatic cyst with small foci (arrows) of contrast extravasation indicating active bleeding. Persistent non-haemorrhagic peritoneal...

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Haemorrhage;
     
     
Two months earlier, contrast-enhanced axial (a..d, in cranio-caudal order), coronal (e) and sagittal (f) reformatted images showed several, mostly large-sized simple liver cysts with fluid attenuation.
 
Moderate dilatation of some intrahepatic bile ducts (arrowheads) was noted, caused by compression from one of the largest cysts. The inferior vena cava is patent and not significantly compressed.
 
Several, mostly large-sized simple liver cysts with fluid attenuation are present throughout the liver. The inferior vena cava is patent and not significantly compressed. No polycystic kidney changes were noted.
 
Coronal (d) and sagittal (f) reformatted images effectively show occupation of the liver by several, confluent giant hepatic cysts, causing marked right diaphragm elevation.
 
Coronal (d) and sagittal (f) reformatted images effectively show occupation of the liver by several, confluent giant hepatic cysts, causing marked right diaphragm elevation. Note moderate dilatation of intrahepatic bile ducts (arrowhead).
 
Unenhanced (f,g), arterial-dominant (h) and venous (i) phase images show both kidneys with normal size, parenchymal thickness and contrast enhancement for age, without cysts and hydronephrosis.
 
Unenhanced (f,g), arterial-dominant (h) and venous (i) phase images show both kidneys with normal size, parenchymal thickness and contrast enhancement for age, without cysts and hydronephrosis.
 
Unenhanced (f,g), arterial-dominant (h) and venous (i) phase images show both kidneys with normal size, parenchymal thickness and contrast enhancement for age, without cysts and hydronephrosis.
 
Unenhanced (f,g), arterial-dominant (h) and venous (i) phase images show both kidneys with normal size, parenchymal thickness and contrast enhancement for age, without cysts and hydronephrosis.
 
Currently, axial images (a..c) show enlargement of the dominant simple hepatic cyst (compared to Fig.1b) corresponding to physical finding, and increased dilatation of intrahepatic bile ducts (arrowheads).
 
The enlarged dominant simple hepatic cyst causes increased dilatation of intrahepatic bile ducts (arrowheads), and compression of the inferior vena cava.
 
The enlarged dominant simple hepatic cyst causes increased dilatation of intrahepatic bile ducts (arrowheads), and compression of the inferior vena cava.
 
Coronal reformatted images (d,e) better depict increased dilatation of intrahepatic bile ducts (arrowheads), caused by compression of the dominant cyst on the liver hilum.
 
Coronal reformatted images (d,e) better depict increased dilatation of intrahepatic bile ducts (arrowheads), caused by compression of the dominant cyst on the liver hilum.
 
Ultrasound-guided percutaneous puncture (a) and drainage positioning (arrowhead in b) was performed on the dominant hepatic cyst, yielding sterile serous fluid.
 
Ultrasound-guided percutaneous puncture (a) and drainage positioning (arrowhead in b) was performed on the dominant hepatic cyst, yielding sterile serous fluid.
 
Days later, post-procedural follow-up contrast-enhanced CT showed dominant hepatic cyst partially collapsed with drainage tube in place (arrowhead).
 
Six months after hospital discharge, urgent unenhanced acquisition because of impaired renal function showed enlarged dominant hepatic cyst, with hyperattenuating material (*) consistent of fresh blood in its dependent part. Note moderate non-haemorrhagic peritoneal effusion.
 
Urgent unenhanced acquisition due to impaired renal function showed enlarged dominant hepatic cyst, filled by hyperattenuating material (*) consistent of fresh blood. Note moderate non-haemorrhagic peritoneal effusion.
 
Coronal reformatted unenhanced images (c, detail in d) confirm enlarged dominant hepatic cyst, with hyperattenuating material (*) consistent with fresh blood in its dependent part. Note moderate non-haemorrhagic peritoneal effusion.
 
Coronal reformatted unenhanced images (c, detail in d) confirm enlarged dominant hepatic cyst, with hyperattenuating material (*) consistent with fresh blood in its dependent part. Note moderate non-haemorrhagic peritoneal effusion.
 
With improved renal function, 24 hours later contrast-enhanced CT including arterial (a,b) and venous (c..e)-phase acquisitions shows stable hemorrhagic (*) giant liver cyst, persistent non-haemorrhagic peritoneal effusion.
 
In the arterial phase acquisition, stable haemorrhagic (*) giant liver cyst is seen without appreciable contrast extravasation indicating active bleeding.
 
Axial (c) and coronal (d, detail in e) venous phase images show giant haemorrhagic (*) hepatic cyst with small foci (arrows) of contrast extravasation indicating active bleeding. Persistent non-haemorrhagic peritoneal effusion.
 
Axial (c) and coronal (d, detail in e) venous phase images show giant haemorrhagic (*) hepatic cyst with small foci (arrows) of contrast extravasation indicating active bleeding. Persistent non-haemorrhagic peritoneal effusion.
 
Axial (c) and coronal (d, detail in e) venous phase images show giant haemorrhagic (*) hepatic cyst with small foci (arrows) of contrast extravasation indicating active bleeding. Persistent non-haemorrhagic peritoneal effusion.
 
 
 
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