Cystic tumor of the liver.

A 63-year-old man with a personal history of arterial hypertension and type II diabetes treated with oral medication for approximately 8 years, presented to the family doctor for occasional discomfort in the right upper quadrant, appearing on and off for the last few months. The family doctor detected important hepatomegaly, liver 6-7 cm bellow the costal rim, not painful, an elastic. The patient was referred to our Department for further evaluation. Apart from hepatomegaly, the clinical exam was in normal range. The laboratory tests revealed: mild anemia (Hb=11.4g%, normal leucocytes, thrombocytes, normal iron) and increased Erythrocytes sedimentation rate (82 mm/1h); normal aminotransferases but with slight cholestasis: ALP=196 IU/l [Upper value of Normal (UVN)=126 IU/l], GGTP=142 IU/l (UVN=72 IU/l), and normal bilirubin; no signs of hepatic insufficiency (normal albumins, INR); negative viral markers for HBV and HCV hepatitis; normal alpha-fetoprotein. The abdominal ultrasound described multiple masses, 7-10 cm in diameter, some anechoic with thick septa and others with mixed content, anechoic and echogenic, that occupied almost the whole liver (fig 1). Contrast enhanced ultrasound (CEUS) was performed that revealed multiple cystic lesions with walls and septa enhancing in the arterial phase and which did not show wash-out in the portal-venous and late phases (fig 2). The echogenic content present in some of the cysts did not enhance following contrast. An abdominal CT with contrast (fig 3) described Fig 1. Liver ultrasound examination: multiple masses 7-10 cm in diameter, some anechoic with thick septa and others with mixed content, anechoic and echodense, that occupy almost the whole liver.