Polycystic liver disease

A 54-year-old man had an asymptomatic elevation of cytolysis-related enzymes, GGT, and alkaline phosphatase, detected at a routine laboratory study. The patient reported no alcohol abuse, no history of liver disease, and no constitutional syndrome. Physical examination showed a good general status, normal colored skin and mucosas, and no stigmata of chronic liver disease. The abdomen was soft, depressible, and slightly tender in the right hypochondrium with hepatomegaly of three finger-widths. There were no signs or symptoms of ascites. A laboratory study for liver disease was also negative. An initial ultrasound study showed the presence of multiple, well-defined anechoic lesions with posterior acoustic enhancement, distributed across the hepatic parenchyma; the kidneys were free of lesions. The study was completed with a liver MRI, which showed hypointense lesions resembling cerebrospinal fluid (CSF) on T1-weighted images, whereas in T2-weighted images with fat saturation lesions were hyperintense (Figs. 1 and 2).