A case of a hemorrhagic hepatic cyst with a contrast-enhancing mural nodule for which it was possible to retrospectively examine the process from a simple cyst

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  • KIYAMA Kanna
    Department of Gastroenterology, Kagoshima City Hospital
  • HASHIGUCHI Masafumi
    Department of Gastroenterology, Kagoshima City Hospital
  • MUROMACHI Kaori
    Department of Gastroenterology, Kagoshima City Hospital
  • TAMAI Tsutomu
    Department of Gastroenterology, Kagoshima City Hospital
  • IWASHITA Yuji
    Department of Gastroenterology, Kagoshima City Hospital
  • NASU Yuichiro
    Department of Gastroenterology, Kagoshima City Hospital
  • HORI Takeshi
    Department of Gastroenterology, Kagoshima City Hospital
  • NAGATA Yuki
    Department of Digestive Surgery, Kagoshima City Hospital
  • SUEYOSHI Kazunobu
    Department of Pathology, Kagoshima City Hospital
  • IDO Akio
    Digestive and Lifestyle Diseases, Department of Human and Environmental Sciences, Kagoshima University Graduate School of Medical and Dental Sciences

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Abstract

<p>Hepatic intracystic hemorrhage is a rare complication of congenital cysts. The imaging findings are often nonspecific and complicated, so it is difficult to differentiate from hepatic cystic tumors. Hemorrhagic hepatic cysts show an internal heterogeneous echo level, intracystic mass-like structure, and septum-like structure on ultrasonography (US), but they are difficult to detect on computed tomography (CT) because the clot has a CT value equivalent to that of the fluid in the cyst, so it is characterized by a discrepancy between the US and CT findings. On the other hand, hepatic cystic tumors have mural nodules that can also be recognized on CT, and various contrast studies show contrast enhancement of mural nodules and septa. We herein report a case with a hemorrhagic hepatic cyst that was suspected at first glance to be a hepatic cystic tumor because CT showed an enhanced mural nodule. A comprehensive evaluation with various modalities is necessary to differentiate cystic lesions of the liver, and contrast-enhanced US (CEUS) in particular may be effective. In the post-vascular phase of CEUS, hepatic cystic tumors were reported to have a contrast effect, which hepatic hematomas due to intracystic hemorrhage were reported not to have, suggesting that this may be a key finding for differentiation. Furthermore, we were able to retrospectively examine the process from a simple cyst by investigating the past imaging studies. It was an interesting change in imaging findings as it showed the natural history from a simple cyst to a hemorrhagic cyst.</p>

Journal

  • Choonpa Igaku

    Choonpa Igaku 49 (1), 57-63, 2022

    The Japan Society of Ultrasonics in Medicine

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