Non-infectious Hepatic Cystic Lesions: A Narrative Review

Hepatic cysts are commonly encountered in clinical practice, presenting a wide spectrum of lesions that vary in terms of pathogenesis, clinical presentation, imaging characteristics, and potential severity. While benign hepatic cysts are the most prevalent, other cystic lesions, which can sometimes mimic simple cysts, may be malignant and pose significant clinical challenges. Simple biliary cysts, the most common type, are typically diagnosed using ultrasound. However, for complex lesions, advanced imaging modalities such as Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) are crucial. In ambiguous cases, additional diagnostic tools such as contrast-enhanced ultrasound (CEUS), Positron Emission Tomography (PET), cyst fluid aspiration, or biopsy may be necessary. Understanding the nuances of these cystic lesions is crucial for accurate diagnosis and management, as it distinguishes between benign and potentially life-threatening conditions and informs the decision on appropriate treatment strategies. Non-parasitic cysts encompass a range of conditions, including simple biliary cysts, hamartomas, Caroli disease, polycystic liver disease, mucinous cystic neoplasms, intraductal papillary mucinous neoplasms, ciliated hepatic foregut cysts, and peribiliary cysts. Each type has specific clinical and imaging features that guide non-invasive diagnosis. Treatment approaches vary, with conservative management for asymptomatic lesions and more invasive techniques, such as surgery or percutaneous interventions, reserved for symptomatic cases or those with complications. This review focuses on non-parasitic cystic lesions, exploring their pathophysiology, epidemiology, risk of malignant transformation, treatment options, and key findings from imaging diagnosis.