Simple liver
cysts are congenital with a prevalence of 2.5%-4.25%. Imaging, whether by US, CT or MRI, is accurate in distinguishing simple
cysts from other etiologies, including parasitic, neoplastic, duct-related, and traumatic
cysts. Symptomatic simple liver
cysts are rare, and the true frequency of symptoms is not known. Symptomatic simple liver
cysts are predominantly large (> 4 cm), right-sided, and more common in women and older patients. The vast majority of simple hepatic
cysts require no treatment or follow-up, though large
cysts (> 4 cm) may be followed initially with serial imaging to ensure stability. Attribution of symptoms to a large simple
cyst should be undertaken with caution, after alternative diagnoses have been excluded. Aspiration may be performed to test whether symptoms are due to the
cyst; however,
cyst recurrence should be expected. Limited experience with both laparoscopic deroofing and aspiration, followed by instillation of a
sclerosing agent has demonstrated promising results for the treatment of symptomatic
cysts. Here, we describe a patient with a large, symptomatic, simple liver
cyst who experienced complete resolution of symptoms following
cyst drainage and alcohol ablation, and we present a comprehensive review of the literature.