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pISSN 2465-7786•eISSN 2465-7794 www.clinicalultrasound.org Received : 2016. 10. 31 Revised : 2016. 11. 28 Accepted : 2016. 12. 19 Address for Correspondence: Si Hyun Bae, M.D., Ph.D. Division of Hepatology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpodae-ro, Seocho-gu, Seoul 06591, Korea Tel: +82-2-2258-6020, Fax: +82-2-3481-4025 E-mail: baesh@catholic.ac.kr A 71-year-old female was referred for huge hepatic cystic mass. She has recent 4-month history of gradual abdominal distension. There was no significant past history and liver function tests were normal. An abdominal ultrasonography (US) and a computed tomography (CT) revealed a huge hepatic cyst approximately 20.0 × 16.0 × 12.7 cm in size that occupied the right liver lobe. The cystic lesion did not enhance postcontrast and appeared to be well circumscribed. But cyst seemed to be contained hyperechoic solid component in the US and faint amorphous hairy materials in the CT. A magnetic resonance imaging showed multiple incomplete septum-like structure and papillary prominences in the cyst. The papillary structure appeared slightly high signal intensity on T1W images and low signal intensity on T2W images. Based on these, the initial diagnosis was a hemorrhagic cyst and differential diagnosis included biliary cystadenoma. Surgical resection of cyst was performed. Intraoperatively, fenestration was performed, evacuating muddy like materials. In the cytology of cystic fluid, the malignant cells are not observed. Histopathological tissue revealed unilocular cyst covered with brownish muddy material and old hemorrhage. There were observed only many RBCs and some pigment-laden macrophage. The wall of cyst was composed of dense fibrous tissue and no epithelial cell was observed with severe degeneration. The final pathological diagnosis was benign cystic lesion with hemosiderin-laden macrophages.

Huge Hemorrhagic Hepatic Cyst Mimicking Cystadenoma: an Unusual Ultrasonographic Finding