1. ¹Department of Internal Medicine, National Naval Medical Center, Bethesda, Maryland, USA
2. ²Nephrology Department, National Naval Medical Center and Uniformed Services of the Health Sciences, Bethesda, Maryland, USA

Correspondence: Fred E. Yeo, Medical Corps, United States Navy, National Naval Medical Center, Bethesda, Maryland 20889, USA. E-mail: Fred.Yeo@Med.Navy.Mil

A 47-year-old woman with autosomal dominant polycystic kidney disease (ADPKD) was evaluated for bilateral (right-sided greater than left-sided), abdominal pain recalcitrant to oral opiates. Physical examination revealed massive hepatomegaly and right costovertebral angle tenderness. Laboratory studies revealed a stable serum creatinine at 1.4 mg per 100 ml and hemoglobin of 13.7 g per 100 ml. Enhanced computed tomography (CT) of the abdomen revealed an expansive dominant right renal cyst and a large dominant cyst in the left hepatic lobe (Figure 1, arrow). The patient underwent CT-guided percutaneous renal cyst aspiration and hepatic cyst fenestration (Figure 2, arrow). The patient's pain resolved following these procedures and narcotic pain medication requirements decreased. The liver is the most common extrarenal location for cyst development in ADPKD. Hepatic cysts may be painful when hepatomegaly is present, and decompression with percutaneous aspiration or fenestration may be necessary for treatment. Sclerosing agents such as ethanol may be used as an adjunctive therapy for renal cyst decompression.

Figure 1.

Dominant liver cyst, pre-procedure.

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Figure 2.

Dominant liver cyst, post-procedure.

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