Massive Unifocal Cyst of the Liver in a Drug Abuser: Case Report and Review of the Literature

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A 20-year-old white male presented, complaining of abdominal fullness. His previous history was unremarkable except for the use of intravenous illicit drugs. Physical examination disclosed a mass filling the upper and lower right quadrants. We evaluated this mass through the use of barium contrast x-ray, sonography and angiography, and made the preoperative diagnosis of hepatic cystic disease. On operative exploration, a large thin-walled cyst was found on the right lobe of the liver and was shown to be free of communication with the biliary tree; 3,000 cc of chocolate colored fluid were aspirated from the cyst. Total removal of the cyst was achieved with careful dissection. The cavity was filled with omentum and closed without drainage. After a benign immediate postoperative course, the patient remains asymptomatic one year later. Although most reports from the literature describe unexpected intraoperative findings, we stress that symptomatic patients can and should be diagnosed prior to laparotomy, and that a thorough search be made for concomitant polycystic disease. Total extirpation of the cyst is the most desirable of the discussed treatments, when tempered by the age and physical condition of the patient. Thorough preoperative evaluation and awareness of different modalities of therapy allow for the correct choice of treatment.

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