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Serologies for parasitic antigens
5%
4/87
Surgical consult for laparoscopic unroofing procedure
1%
1/87
Percutaneous aspiration
16%
14/87
Reassure the patient and instruct her to return if symptomatic
68%
59/87
CT abdomen
8%
7/87
Select Answer to see Preferred Response
The patient has a simple hepatic cyst. Because the patient is asymptomatic, there is no treatment necessary. Simple hepatic cysts are found in approximately 1% of adults, and most are asymptomatic. Symptoms may include abdominal pain, nausea, vomiting, and weight loss. While percutaneous aspiration was previously used, it is no longer recommended due to a high rate of recurrence. Symptomatic patients may require surgical intervention, most commonly laparoscopic unroofing and resection. Also on the differential diagnosis is echinococcal cysts (hydatid disease), cystadenocarcinoma, and hepatic mucinous cystic neoplasm (cystadenoma), which typically can be distinguished from simple cysts on ultrasonography. Additionally, hepatic adenomas are associated with oral contraceptive pill use. Chrieki discusses the presentation, diagnosis, and treatment of echinococcus. In contrast to a simple hepatic cysts, echinococcosis commonly presents as a fluid filled hepatic mass with a well-defined outer wall and internal septations. Appropriate treatment involves surgery and/or albendazole. There is a risk of anaphylaxis with cyst rupture. Hansman et al. reviewed the surgical management and outcomes of patients with symptomatic hepatic cysts, and suggests an algorithm for surgical management of symptomatic hepatic cysts. They emphasize that simple cysts lack true septations and that laparoscopic unroofing of simple cysts is indicated in solitary cysts. Illustration A demonstrates the surgical treatment algorithm for hepatic cysts. Illustration B depicts how a simple liver cyst appears on CT imaging. Incorrect answers: Answer 1: Serologies will be positive in patients with echinococcal cysts, but given the description of the ultrasound findings, echinococcus is unlikely. Answer 2: The patient is asymptomatic at this time and does not require surgical intervention. Answer 3: Percutaneous aspiration of simple cysts is associated with a high rate of recurrence. Answer 5: Additional imaging is currently not necessary at this time.
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