Massive cystic hepatomegaly, suspected polycystic liver disease
Recommended: CT or MRI Abdomen is the preferred imaging study for massive cystic hepatomegaly, suspected polycystic liver disease. Isolated polycystic liver disease (PRKCSH, SEC63 mutations) or part of ADPKD.
Recommended study
CT or MRI Abdomen
Isolated polycystic liver disease (PRKCSH, SEC63 mutations) or part of ADPKD. Compressive symptoms in massive disease.
If the default doesn't apply
Suspected ADPKD
US
Add renal evaluation (US or MRI)
No contrast
Watch-outs
Symptomatic compression
Mass effect on IVC, biliary system, gastric outlet → consider aspiration-sclerosis, fenestration, or transplant.
Pearls
- Cyst infection → DWI restriction + rim enhancement; hot to FDG-PET.
- Distinguish from biliary hamartomas (von Meyenburg complexes) — small (< 1.5 cm), non-communicating.
- Estrogen worsens disease — counsel premenopausal patients.