Description

      A sixty-eight years old female with a past medical history of Autosomal Polycystic Kidney Disease (ADPKD), renal transplant, and adenocarcinoma of the colon with prior resection and chemotherapy presented to the emergency department with acute abdominal pain. On physical exam, she was afebrile, had distended abdomen, hepatosplenomegaly, mild mid-abdomen tenderness, and hypoactive bowel sounds. Laboratory studies showed stable stage III-b chronic kidney disease, chronic normocytic anemia, normal coagulation profile, without transaminitis, and hyperbilirubinemia. Ultrasound revealed multiple hepatic cysts. Subsequent abdominal MRI revealed parenchymal replacement of the liver by innumerable cysts. Fluids sent from percutaneous aspiration of a predominant cyst failed to show evidence of infection or malignancy. She was not a suitable liver transplant candidate and cyst aspirations would be unlikely to provide substantial relief of symptoms. She was managed conservatively with small meals, narcotics, and antiemetics.

      Polycystic Liver Disease (PLD) commonly found in ADPKD patients, mainly in females [1]. PLD remain asymptomatic and found incidentally. However, hepatic cysts are susceptible to various complications such as infections, hemorrhage, torsion, rupture, and malignant transformation [2]. The diagnostic workup for a suspected complication of hepatic cysts includes laboratory studies which may show normal liver function test and radiological diagnostics using ultrasound, CT scan, and MRI of the liver. Interventions include percutaneous aspiration with sclerotherapy, liver resection with transplantation, and adequate supportive measures and symptom control [3].