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Haemorrhagic hepatic cyst: a differential diagnosis of cystic tumour

¹ Departments of Radiology
² 2nd Surgery
³ Pathology, Osaka City University Medical School, 1-4-3 Asahimachi, Abeno, Osaka 545-8585, Japan

View larger version (126K): [in a new window]   Figure 1. Non-contrast CT. A cystic mass is seen in the right lobe of liver. The cyst wall is partially calcified and appears ill defined as a result of partial volume effect on this image. A mural nodule is seen on the ventral aspect of the cystic mass.

View larger version (143K): [in a new window]   Figure 2. Coronal T1 weighted spoiled gradient echo image (TR/TE/flip angle 79.7/7.1/90). The margin of the cystic lesion is well defined and the cyst wall is thin and smooth. The fluid is homogeneously hyperintense and the mural nodule is hypointense.

View larger version (127K): [in a new window]   Figure 3. Axial T1 weighted spoiled gradient echo image (TR/TE/flip angle 146.1/4.1/90). The mural nodule is hypointense. As a result of partial volume effect, the margin of the cystic lesion is unclear and the fluid appears heterogeneously hyperintense.

View larger version (130K): [in a new window]   Figure 4. Axial T2 weighted spin echo image (TR/TE/flip angle 2014/80/65). The fluid is heterogeneously hyperintense with linear isointense areas, and the mural nodule is hypointense.

View larger version (121K): [in a new window]   Figure 5. Enhanced axial T1 weighted spoiled gradient echo image (TR/TE/flip angle 146.1/4.1/90). Focal enhancement is noted in the mural nodule (arrow).

View larger version (158K): [in a new window]   Figure 6. Gross specimen. A thin and smooth cyst wall and a mural nodule are seen.

View larger version (126K): [in a new window]   Figure 7. Pathological specimen of the mural nodule (x10). The cyst wall is composed of fibrous tissue, and epithelial cells are absent. The outer portion of the wall is the liver parenchyma, while the upper portion of the wall is the mural nodule.