Intracystic haemorrhage in a patient with polycystic liver disease – a case report

Aims: Polycystic liver is an autosomal dominant hereditary disease commonly associated with polycystic kidney disease. Most of these cysts cause no symptoms. Large hepatic cysts tend to be symptomatic and can cause more complications (haemorrhage, infection, rupture and torsion) than smaller ones. Case report: We report here on a patient with polycystic liver disease who later developed upper abdominal pain due to intracystic haemorrhage. At the age of 44 years in 2006, she was referred to our hepatology unit for verification of her polycystic liver disease. Her hepatomegaly was diagnosed at the time of the labour with her third child. Abdominal ultrasonography (US) revealed numerous cysts (from 10 to 90mm in diameter) in her liver, while the blood vessels and bile ducts were intact, and there were no cysts in her kidneys or pancreas. She had no complaints, her liver function tests were normal, and her virological (HBsAg and anti-HCV) and tumour markers (AFP and CA19–9) were negative. Her mother too had polycystic liver, but her children were cyst-free. A regular 6-month follow-up, including laboratory and US controls, was proposed. In January 2007, severe pain developed in the right subcostal region. The first examinations (US and blood tests) demonstrated inner echoes in the largest cyst as a consequence of intracystic haemorrhage, but without a significant decrease in the serum haemoglobin level or any impairment of the liver function. In February 2007, the patient underwent US-guided drainage followed by the instillation of povidone-iodine. The cyst diminished in size and the patient has subsequently remained symptom-free. Conclusions: Percutaneous aspiration and sclerotherapy is a safe, effective and minimally invasive method of treatment of intracystic haemorrhage in polycystic liver disease. A patient with large hepatic cysts may benefit from this intervention by preventing further complications.