Panchal M, Alansari A, Wallack M, Visco F, Williams S, Sy AM

Language: English
References: 14
Page: 165-168
PDF size: 232.68 Kb.

ABSTRACT

Commonly reported complications of hepatic cysts are spontaneous hemorrhage, rupture into the peritoneal cavity, infection and compression of the biliary tree however cardiac complications are not commonly reported. We are presenting a case of a large liver cyst presenting with right atrial and ventricular inflow tract impingement resulting in cardiac symptoms. A 68 year-old Hispanic female presented with one month of fatigue and shortness of breath after household work and walking less than one block, right upper quadrant pain and weight loss. She had history of multiple hepatic cysts for more than 12 years, well-controlled diabetes and hypertension. Examination of the heart revealed tachycardia with regular heart sounds. There were no murmurs. She had tenderness in her right upper quadrant on palpation and an enlarged smooth liver. Rest of physical examination was unremarkable. CT scan of the abdomen showed multiple non-enhancing liver cysts in both lobes, with the largest measuring 12 x 15 x 17 cm which was significantly increased from her baseline of 7 x 8 x 10 cm in 2003. Echocardiogram showed normal left ventricular ejection fraction, grade 1 diastolic dysfunction and a hepatic cyst impinging RA and RV inflow tract. She had successful laparoscopic enucleation of liver cyst and subsequent relief from tachycardia, fatigue and shortness of breath. In conclusion, this case illustrates that hepatic cysts may become symptomatic after remaining quiescent for an extended period. They may present with unusual symptoms and clinicians should be mindful of rare complications, such as in this case.

REFERENCES

1. Caremani M, Vincenti A, Benci A, Sassoli S, Tacconi D. Ecographic epidemiology of non-parasitic hepatic cysts. J Clin Ultrasound 1993; 21: 115-8.

2. Carrim ZI, Murchison JT. The prevalence of simple renal and hepatic cysts detected by spiral computed tomography. Clin Radiol 2003; 58: 626.

3. Miliadis L, Giannakopoulos T, Boutsikos G, Terzis I, Kyriazanos ID. Spontaneous rupture of a large non-parasitic liver cyst: a case report. J Med Case Rep 2010; 4: 2.

4. Lantinga MA, Geudens A, Gevers TJ, Drenth JP. Systematic review: the management of hepatic cyst infection. Aliment Pharmacol Ther 2015; 41: 253-61.

5. Macutkiewicz C, Plastow R, Chrispijn M, Filobbos R, Ammori BA, Sherlock DJ, Drenth JP, et al. Complications arising in simple and polycystic liver cysts. World J Hepatol 2012; 27: 406-11.

6. Moon1 J, Heo D, Han S. A case of hepatic cyst-induced inferior vena cava thrombosis. Pak J Med Sci 2014; 30: 667-70.

7. Ker J. The liver and right atrium - hepatic cyst as a cause of arrhythmia. Clin Med Insights Cardiol 2010; 4: 63-7.

8. Lasic LB, DeVita MV, Spiegel PJ, Marino ND, Mellow E, Michelis MF. Refractory hypotension and edema caused by right atrial compression in a woman with polycystic kidney disease. Am J Kidney Dis 2004; 43: 13-7.

9. Ghatak T, Azim A, Sharma A, Mahindra S: Post-operative refractory hypotension due to right heart Compression by hepatic cysts in a patient with autosomal Dominant polycystic kidney disease. J Anesthesiol Clin Pharmacol 2013; 29: 572-4.

10. O'Connor A, Lee M, McEntee G, McNamara DA. Massive hepatic cyst presenting as right-sided heart failure. Ir J Med Sci 2012; 181: 365-7.

11. Li Vecchi M, Buscemi S, Nardi E, Azzolina V, Provenzano R. A case of cardiac compression by hepatic cyst in a woman with polycystic kidney disease. Intern Emerg Med 2008; 3: 69-71.

12. Egbuna O, Johnson S, Pavlakis M. Rupture of an Infected Liver Cyst into the Pericardium in a Kidney Transplant Recipient with Polycystic Kidney Disease. Am J Kidney Dis 2007; 49: 851-3.

13. Spârchez Z, Radu P, Zaharie F, Al Hajjar N, Spârchez M. Percutaneous treatment of symptomatic non-parasitic hepatic cysts. Initial experience with single-session sclerotherapy with polidocanol. Med Ultrason 2014; 16: 222-8.

14. Antonacci N, Ricci C, Taffurelli G, Casadei R, Minni F. Systematic review of laparoscopic versus open surgery in the treatment of non-parasitic liver cysts. Updates Surg 2014; 66: 231-8.