Massive simple hepatic cyst triggered sudden cardiac arrest in a middle-aged, female patient due to compression of the right heart

Liver cysts are common, often remain clinically silent and need treatment only if symptoms occur. A 65-year-old woman presented with abdominal bloating and swelling due to a massive liver cyst (190×210mm). Urgent surgical treatment (laparoscopic deroofing) was planned. Before the surgical date the patient suffered a nonfatal cardiac arrest, likely due to a cardiac compression by the cyst. This is a rare case of a liver cyst causing a very serious cardiac adverse event. Pre-event, there were no signs of cardiac decompensation. We want to highlight the importance of early surgical treatment of large liver cysts, even in patients with mild symptoms.