title: Intracystic hemorrhage of a simple hepatic cyst.
abstract: An unusual case involving hemorrhage of a benign intrahepatic cyst in which the correct diagnosis was made preoperatively is reported. A 60-year-old man presented with acute onset of left upper quadrant abdominal pain. On admission, computed tomography and ultrasonography revealed an 8-cm hepatic cyst in the left lateral segment of the liver. Serum concentrations of CA19-9 (170 mu/mL), DUPAN2 (1600 mu/mL), and SPAN1 (94 mu/mL) were elevated. Twenty-three days after admission, magnetic resonance imaging revealed a hyperintense 13-cm lesion that appeared heterogeneous on T1-weighted sequences and relative hypointensity of the bottom on T2-weighted sequences. Percutaneous transhepatic drainage of the cyst was performed 27 days after admission, and serosanguineous fluid was obtained; abdominal pain resolved. Tumor marker concentrations decreased by 1 week after drainage. Six days after drainage, the drainage fluid became purulent. The infection persisted and a left lateral segmentectomy and cholecystectomy were performed 24 days after the cyst was drained. Pathology confirmed that the cyst was benign. The use of magnetic resonance imaging and tumor markers may allow the differentiation of benign hepatic cyst from malignant lesions and obviate the need for surgery.
authors.affiliation: First Department of Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yoshida
authors.forename: Masahiko
authors.initials: M
authors.lastname: Onda
authors.forename: Takashi
authors.initials: T
authors.lastname: Tajiri
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Mamada
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Taniai
authors.forename: Eiji
authors.initials: E
authors.lastname: Uchida
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Arima
authors.forename: Koho
authors.initials: K
authors.lastname: Akimaru
authors.forename: Kiyohiko
authors.initials: K
authors.lastname: Yamashita
mesh_terms: D002763:Cholecystectomy; D002769:Cholelithiasis / Q000175:diagnosis / Q000601:surgery; D003560:Cysts / Q000175:diagnosis* / Q000601:surgery; D006470:Hemorrhage / Q000175:diagnosis* / Q000601:surgery; D006498:Hepatectomy; D006801:Humans; D008107:Liver Diseases / Q000175:diagnosis* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000601:surgery; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography