Table of contents

Hepatic cyst


Key sources

The following summarized guidelines for the evaluation and management of hepatic cyst are prepared by our editorial team based on guidelines from the European Association for the Study of the Liver (EASL 2022) and the American College of Gastroenterology (ACG 2014). ...
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Diagnostic investigations

Diagnostic imaging: as per EASL 2022 guidelines, obtain ultrasound as the first-line imaging for the diagnosis of hepatic cysts.
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  • Evaluation of mucinous cystic neoplasms

  • Evaluation of cyst infection

  • Evaluation of cyst hemorrhage

  • Evaluation of Caroli disease/syndrome

Therapeutic procedures

Drainage: as per EASL 2022 guidelines, offer the best locally available volume-reducing therapy for the treatment of symptomatic simple hepatic cysts without biliary communication.

Surgical interventions

Laparoscopic deroofing: as per ACG 2014 guidelines, consider performing laparoscopic deroofing rather than aspiration and sclerotherapy, dictated based on the availability of local expertise, in symptomatic patients with simple hepatic cysts.

Specific circumstances

Patients with cyst infection, antibiotic therapy: as per EASL 2022 guidelines, administer fluoroquinolones and third-generation cephalosporins for 4-6 weeks
as empirical first-line antibiotics in patients with hepatic cyst infection.

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  • Patients with cyst infection (secondary prophylaxis)

  • Patients with cyst hemorrhage

  • Patients with cyst infection (drainage)

  • Patients with mucinous cystic neoplasms

  • Patients with biliary hamartomas

  • Patients with Caroli disease/syndrome

Follow-up and surveillance

Serial imaging assessment: as per EASL 2022 guidelines, do not monitor asymptomatic patients with simple hepatic cysts or peribiliary cysts.
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  • Expectant management