ConditionDigestive system
Liver Cysts
Liver cysts are fluid-filled sacs within the liver. Most are simple cysts: benign, present from birth, and found by chance on an ultrasound or CT scan done for another reason. They are common, seen in roughly 2 to 5% of people on imaging and more often in women and older adults. Most cause no symptoms and need no treatment. Large cysts can cause fullness or pain, and a few types, such as parasitic or mucinous cysts, need specific treatment.
Also called: Hepatic cysts, simple liver cyst, cyst of the liver, bile duct cyst (biliary cyst), polycystic liver
At a glance
- What it is
- A fluid-filled sac in the liver, usually benign.
- Most common type
- Simple cyst; thin-walled, clear fluid, no solid parts.
- Other types
- Polycystic liver disease, hydatid (parasitic) cysts, mucinous cystic neoplasms, abscesses.
- Symptoms
- Usually none; large cysts can cause upper right abdominal fullness or pain.
- Diagnosis
- Ultrasound, CT or MRI.
- Treatment
- None for most; drainage with sclerotherapy, keyhole surgery or specific therapy for symptomatic or complex cysts.
When to get help
Call 911 or go to the ER
- Sudden severe upper abdominal pain, especially with dizziness or fainting (possible bleeding or rupture of a cyst)
- Fever with shaking chills and right upper abdominal pain (possible infected cyst or abscess)
See a doctor within a day or two
- Yellowing of the skin or eyes, dark urine or pale stools
- Persistent right upper abdominal pain, nausea or feeling full quickly
Book a routine appointment
- A liver cyst found on a scan that is described as complex, septated or with a thick wall or solid parts
- A large cyst, or many cysts, found incidentally
- A liver cyst in someone who has lived in sheep- or cattle-raising areas abroad
Types of liver cysts
| Type | Features | Typical management |
|---|---|---|
| Simple (biliary) cyst | Thin wall, clear fluid; one or a few | No follow-up if typical and asymptomatic |
| Polycystic liver disease | Many cysts; often with polycystic kidney disease | Monitor; treat if liver becomes very large and symptomatic |
| Hydatid cyst | Caused by the tapeworm Echinococcus; daughter cysts and wall calcification | Antiparasitic medicine, drainage or surgery |
| Mucinous cystic neoplasm | Thick wall, internal partitions or nodules; almost always in women | Surgical removal, because of a small cancer risk |
| Liver abscess | Infected collection; fever and pain | Antibiotics and drainage |
| Choledochal cyst | Dilated bile duct, usually found in childhood | Surgical removal |
Simple cysts
Simple cysts arise from bile duct tissue that did not connect during development. They do not turn into cancer. They may grow slowly over years. Most are under 5 cm, but some reach 10 cm or more.
Polycystic liver disease
This inherited condition causes many cysts throughout the liver, most often alongside autosomal dominant polycystic kidney disease, or less often as an isolated liver condition. Cysts are more numerous and larger in women, and estrogen (pregnancy, hormone therapy) can promote their growth. Liver function usually stays normal even when the liver is very enlarged.
Hydatid cysts
Echinococcosis is caught by swallowing tapeworm eggs from dog feces, usually in rural areas where dogs eat raw offal from sheep or cattle. Cysts grow slowly and may cause pain, jaundice or, if they rupture, a severe allergic reaction. Diagnosis uses imaging and blood antibody tests.
Symptoms
Most liver cysts cause no symptoms. Large cysts, usually over 5 to 10 cm, or polycystic liver disease can cause:
- a dull ache or fullness under the right ribs
- bloating and feeling full quickly after eating
- shortness of breath or reflux from pressure on nearby organs
- a visible swelling of the upper abdomen
Complications are uncommon: bleeding into the cyst, infection, rupture, or pressure on the bile duct causing jaundice.
Diagnosis
- Ultrasound is usually where cysts are first seen and readily distinguishes simple cysts from solid masses.
- CT or MRI characterize complex features such as septations, wall thickening, nodules or calcification.
- Blood tests: liver function, and Echinococcus antibodies if hydatid disease is possible. Tumor markers may be checked for complex cysts.
- Kidney imaging if many liver cysts are found, to look for polycystic kidney disease.
A typical simple cyst with no symptoms generally needs no further scans. Complex cysts need specialist review.
Treatment
No treatment
For simple cysts without symptoms, no treatment or follow-up is usually required.
Symptomatic simple cysts
- Aspiration and sclerotherapy: the fluid is drained with a needle under imaging guidance and an alcohol solution is injected to seal the cyst lining. Drainage alone usually leads to refilling.
- Laparoscopic deroofing (fenestration): keyhole surgery to remove the top of the cyst so fluid drains into the abdomen, where it is absorbed. Recurrence is low.
Polycystic liver disease
Options include avoiding estrogen therapy, somatostatin analogs that can slow liver growth, cyst drainage or deroofing, partial liver resection, and, rarely, liver transplantation for severe disease.
Other cysts
- Hydatid cysts: albendazole, often with percutaneous drainage (PAIR) or surgery, at specialist centers.
- Mucinous cystic neoplasms: complete surgical removal.
- Abscesses: antibiotics and drainage.
Frequently asked questions
Are liver cysts dangerous?
Most are not. Simple liver cysts are benign, rarely cause symptoms, and do not turn into cancer. Complex cysts with thick walls, partitions or solid parts, and parasitic cysts, need specialist assessment and sometimes treatment.
What causes liver cysts?
Simple cysts form during development from bile duct tissue and are present from birth, though usually found in adulthood. Other causes include inherited polycystic disease, infection with Echinococcus tapeworms, and rarely cystic tumors.
Do liver cysts need to be removed?
Usually not. Treatment is needed only if a cyst causes symptoms, grows large, becomes infected or bleeds, or has features suggesting a tumor or parasite. Options include drainage with sclerotherapy or keyhole surgery.
Can liver cysts cause pain?
Small cysts typically do not. Large cysts, usually over 5 to 10 cm, can cause a dull ache or fullness under the right ribs, early fullness when eating or bloating. Sudden severe pain may mean bleeding or rupture and needs urgent care.
Sources
This guide was written from current patient and clinical guidance, including:
- American College of Gastroenterology: Clinical guideline on diagnosis and management of focal liver lesions
- European Association for the Study of the Liver: Clinical practice guidelines on management of cystic liver diseases
- MedlinePlus: Liver cysts (polycystic liver disease)
- American Liver Foundation: Liver cysts
- World Health Organization: Echinococcosis fact sheet