Hepatic Infections: Hepatitis, Abscess & Cysts with Dr. Alex Bondoc
With Dr. Alex Bondoc · hosted by Dr. Tom Basch · Grand Rounds
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
More about simple hepatic cyst
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What the experts said
Simple hepatic cysts are predominantly found in women, especially symptomatic cysts, with one study showing a 1 to 9 male to female predominance in symptomatic simple hepatic cysts.
Simple hepatic cysts are more often noted in the right lobe, probably due to mass issue because the right lobe is larger than the left.
Symptomatic simple hepatic cysts are definitely larger and complications can occur, but they are very rare.
Physical exam findings in echinococcal cysts might include pleuritic pain due to transit between abdominal and thoracic cavity, and a rub heard when listening to the liver.
The mass of the right lobe is usually about 60% of the liver and the blood flow to the right lobe accordingly is bigger, so infectious agents preferentially head to the right liver.
The most feared complication of intervention on echinococcal cysts is rupture causing anaphylaxis from spilling cystic material.
Treatment for echinococcal cysts includes pre- and post-operative anti-parasitic albendazole.
The WHO has a classification system for hydatid disease that grades it based on the presence of active daughter cysts.
When daughter cysts are more predominant in echinococcal disease, open surgery with packing and double suction is favored over PAIR technique.
PAIR technique stands for puncture, aspiration, injection and re-aspiration, used to treat cystic disease of liver.
Ciliated hepatic foregut cyst is histologically analogous to a bronchogenic cyst, with ciliated pseudostratified columnar epithelium, followed by smooth muscle, connective tissue, and a fibrous capsule.
Ciliated hepatic foregut cyst can transform into a frank malignant squamous cell carcinoma.
25% of hepatic abscesses occur in the first year of life and 50% in the first 5 years of age.
Risk factors for hepatic abscess include instrumentation of the biliary tree, diabetes, proton pump inhibitor use, chronic granulomatous disease, and immunosuppression.
Common organisms in hepatic abscess are E. coli and Klebsiella (enteric gram-negative rods), and gram-positive cocci including Strep pyogenes and Staph aureus.
In the modern period, one author suggested Staph to be the most common organism in hepatic abscess.
If Strep milleri is cultured from a hepatic abscess, one would be obligated to look for disseminated infection, specifically ocular and neuraxial infection.
For hepatic abscesses greater than 5 centimeters, there is more propensity to leave a catheter rather than just aspirate and treat with antibiotics.
Treatment for hepatic abscess includes 4 to 6 weeks of IV antibiotics followed by 4 to 6 weeks of oral antibiotics.
Imaging features that might be concerning for malignancy in hepatic cysts include calcification, septations, and a thicker rim.
An algorithm for managing simple hepatic cystic disease uses a size cutoff of 4 centimeters for concern.
For asymptomatic hepatic cysts less than 4 centimeters, no follow-up imaging is recommended by the algorithm.
Aspiration and sclerosis for symptomatic hepatic cysts has a recurrence rate in the low single digit range according to retrospective data.
Surgical cyst unroofing with packing or argon ablation has a recurrence rate of 0 to 14% across various series.
Complications of surgical cyst unroofing include post-operative bleeding, development of an abscess, or bile leak.
Sclerosis for hepatic cysts uses 70% ethanol, with risks including ethanol toxicity.
Mucinous cystic neoplasm of the liver is very similar in histologic appearance to the mucinous cystic neoplasm of the ovary.
Mucinous cystic neoplasm often occurs more in adults and females, and it's often symptomatic as a true neoplasm rather than a simple cyst.
It is important to differentiate whether a mucinous cystic neoplasm is a non-invasive version or associated with an invasive carcinoma, which is often difficult on axial imaging or ultrasound.
It is not a great idea to biopsy mucinous cystic neoplasm because you can seed the peritoneum or the tract, especially if it's an invasive carcinoma.
The treatment for mucinous cystic neoplasm is resection, though the entity is exceedingly rare.
Echinococcal cysts represent the larval stage of a dog tapeworm, with ova traveling via the intestine through an enteral route through the portal vein.
Most echinococcal cysts are single cysts.