Non-parasitic diseases of the liver and intrahepatic biliary tree

Abstract

With the widespread use of sensitive imaging techniques, the frequency of non-parasitic liver cysts is increasingly reported. It is a rare clinical entity that is identify through the common use of computed tomography and ultrasonography [1-4]. Their reported prevalence is estimated to be between 0.8% and 3.8% [5] during routine abdominal ultrasound examinations. They derive from a congenital malformation, inherited or non-inherited, of the intrahepatic bile ducts. The large majority of hepatic cysts are lined with a simple epithelial layer with cuboidal cells, suggesting a biliary origin. According to von Meyenburg, [6] embryologic maldevelopment leads to excessive numbers of intralobular ducts that progressively accumulate fluid and eventually become cystic. Using simple imaging techniques such as ultrasound (US), they can be categorized as solitary or multiple and could be well differentiated from a solid hepatic tumor. Appropriate preoperative differentiation between congenital, parasitic, and neoplastic liver cysts by imaging techniques is crucial since treatment options may vary from observation in asymptomatic congenital liver cysts to surgical treatment in parasitic and neoplastic hepatic cysts. Surgical management is warranted, when patients are symptomatic or when cysts cause complications, such as torsion [7], hemorrhage [8], rupture [9], infection [9], malignant degeneration [10], portal hypertension [11], or obstructive jaundice [12]. The treatment of choice is complete excision, enucleation, or resection when it can be performed safely. Partial excision can be used to alleviate symptoms in 43% of patients with polycystic liver disease. Aspiration can be used as a temporary measure to alleviate symptoms while preparing the patient for a more definite procedure. Other treatment options for minimally invasive therapy include laparoscopic treatment and alcohol sclerotherapy [13, 14]. © 2006 Springer-Verlag/Wien.