Presentation
Incidental finding on staging CT for rectal cancer.
Patient Data
The patient has a visible rectal cancer, and this study was performed to stage the disease.
There is a solitary, well-defined, intermediate attenuation lesion (50 HU) in a subcapsular location within segment 4 of the liver (medial segment of the left lobe).
MRI liver with contrast confirms a solitary lesion in segment 4. The lesion has a fluid signal on T2 imaging, consistent with a cystic lesion with subtle layering suggesting internal content.
There is no communication to the biliary tree demonstrated.
The lesion is isointense with liver parenchyma on pre-contrast T1 fat sat imaging, indicating proteinaceous content.
No enhancing complexity or nodule on post-contrast imaging.
Case Discussion
Congenital hepatic foregut cysts are often found incidentally and have a classic location and imaging appearance.
They are often solitary, subcapsular, in the medial segment of the left lobe, with imaging features not quite typical for a simple hepatic cyst (T1 isointense due to proteinaceous content).
They are relatively rare incidental findings. There are case reports of malignant transformation. Some centers advocate resection, but practice varies between institutions, with clear evidence for optimum management lacking.
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