Imaging findings of hemorrhagic hepatic cysts with enhancing mural nodules

  • Shigeshi KohnoEmail author
  • Shigeki Arizono
  • Hiroyoshi Isoda
  • Akihiko Yoshizawa
  • Kaori Togashi
Special Section: Distinguished Papers from JSAR



This study aimed to evaluate the clinical and radiological findings of hemorrhagic hepatic cysts with enhancing mural nodules.


The radiology databases of five facilities were retrospectively searched for reports indicating hemorrhagic hepatic cysts or hepatic cystic tumors. Cases of hemorrhagic hepatic cysts with enhancing mural nodules based on pathological or radiological findings were identified and reviewed.


We included 14 cases (11 female and 3 male) with a mean patient age of 72.6 years. Up until the enhancing mural nodules were detected, the cysts had decreased in size in all ten cases for which radiological imaging was available for a period of > 3 years previous to detection. Dynamic contrast-enhanced CT or MRI showed focal enhancement in the early phase and progressive centrifugal enhancement in the delayed phase in all 16 mural nodules ≥ 10 mm in diameter. Thirteen of 14 MRI assessable enhancing mural nodules ≥ 10 mm in diameter showed a hypointense rim with central hyperintensity on T2-weighted imaging. All cases showed calcification of the cyst wall. In the three referred cases, 18F-fluorodeoxyglucose (FDG) positron emission tomography/CT demonstrated no intense FDG uptake in the enhancing mural nodules. In the four resected cases, histopathology of the enhancing mural nodules revealed neovascularization within an organized hematoma, including extensive dilated vessels and hemangioma-like lesions.


Features including a decrease in cyst size, a progressive centrifugal enhancing pattern on dynamic contrast-enhanced CT or MRI, a hypointense rim with central hyperintensity on T2-weighted MRI, and cyst wall calcification may indicate a hemorrhagic hepatic cyst.


Hemorrhagic hepatic cyst Intracystic hemorrhage Organized hematoma Cystic liver lesion Computed tomography Magnetic resonance imaging 



The authors are grateful to S. Kubo and R. Okumura (Department of Radiology, Kitano Hospital, The Tazuke Kofukai Medical Research Institute, Osaka, Japan), Y. Hirokawa and T. Itoh (Department of Radiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan), H. Ueda (Department of Diagnostic Radiology, Kobe City Medical Center General Hospital, Kobe, Japan), T. Shiozaki and K. Itoh (Department of Diagnostic Imaging, Osaka Red Cross Hospital, Osaka, Japan) for their cooperation with collection of the cases presented in this study and for their permission to include them in this study. We also would like to thank T. Sato and T. Ohno (Department of Diagnostic Imaging and Nuclear Medicine, Kyoto, Japan) for their assistance with gathering the information and images of precious cases. We also appreciate the advice of R. Yamashita (Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, United States) and M. Minami (Department of Radiology, University of Tsukuba Hospital, Ibaraki, Japan). We thank Karl Embleton from Edanz Group ( for editing a draft of this manuscript.


No funding was received for this study.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required. This article does not contain any studies with animals performed by any of the authors.

Informed consent

Formal consent was not required for this retrospective study.


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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Diagnostic Imaging and Nuclear MedicineKyoto University Graduate School of MedicineKyotoJapan
  2. 2.Department of Diagnostic PathologyKyoto University HospitalKyotoJapan

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