A Diagnostic Dilemma in Hepatic Cystic Lesions: Radiological Mimicry of Biliary Cystadenoma and Hydatid Cyst in a Histologically Confirmed Simple Hepatic Cyst

Hepatic cystic lesions pose diagnostic challenges due to overlapping imaging features, as simple hepatic cysts may mimic biliary cystadenoma or hydatid cysts. We report a 43-year-old female with chronic right lower abdominal pain, initially diagnosed with hydatid cyst on ultrasonography and later suspected as biliary cystadenoma on CT and MRI. She underwent laparotomy with cyst excision and cholecystectomy, but histopathology confirmed a simple hepatic cyst. This case highlights the limitations of radiology in differentiating hepatic cystic lesions, the crucial role of histopathology-particularly the absence of ovarian-like stroma-in establishing diagnosis, and the importance of imaging-pathology correlation for accurate management and avoiding inappropriate treatment.