Mirizzi Like-Syndrome Presentation of a Giant Liver Cyst in a 45-Year-Old Hispanic Man

Introduction: Giant liver cysts are rare cystic lesions that are larger than 10cm which may be congenital or acquired. Here, we report a case of a mirizzi-like presentation of a giant liver cyst causing jaundice and abdominal pain in a 45 year-old man. Case Description/Methods: A 45-year-old Hispanic man with a history of traumatic MVA status post abdominal surgery and GERD presented to our facility with abdominal pain and jaundice onset 2 weeks. Initial laboratories revealed a t.bili of 15.2 and d.bili of 7.2. CT of the abdomen at the ED showed a large 11cm x 13cm x 13cm simple fluid density lesion at the hepatic hilum. Follow-up MRCP revealed that there was mass effect on the biliary confluence causing intrahepatic biliary duct dilatation. Studies were negative for amoebic and echinococcus antibodies, acute hepatitis panel, and tumor markers were normal. The patient underwent drainage of the liver cyst by IR where 1L of thick brown fluid was removed. Cultures were obtained however no pathogens were identified. Bilirubin levels only showed mild improvement thus IR was reconsulted for a percutaneous transhepatic cholangiogram which was diagnostic of high biliary stenosis of unknown etiology. Given the history of traumatic MVA requiring extensive abdominal surgery, we consider the possibility that the high-grade stenosis and the resulting cyst may have originated from the trauma/surgery. After internalization of the biliary drain, the patient was discharged home with HHC and close follow-up for outpatient surgery in accordance with the surgeon on the case. Discussion: Hepatic cysts can be classified by their etiologies into congenital, traumatic, infectious, or neoplastic cysts. Although mostly asymptomatic, they can present with infection, hemorrhage, and biliary tree compression. Traumatic liver cysts are among the less frequently reported sequelae of liver trauma. Treatment of symptomatic cysts can be divided into two categories: percutaneous intervention and surgical procedure. Regular follow-up and monitoring are essential to detect any potential recurrence or new cysts. The prognosis for giant liver cysts is generally favorable, with appropriate management and treatment most patients experience relief and improvement in quality of life (Figure 1).Figure 1.: Left and right images show axial and coronal views of a giant liver cyst.