An elderly female presented to the ER with severe abdominal pain. She underwent an evaluation including a CT of the abdomen and pelvis. The only finding was the presence of simple hepatic cyts. She was discharged from the ER. Three days later, she returned again with severe abdominal pain. A repeat CT of the abdomen was done and it showed a seemingly spontaneous rupture of one of the hepatic cysts (see image above with arrows pointing to the ruptured cyst). There was blood in the pelvis associated with this rupture.

Hepatic cysts are a relatively uncommon condition in the first place and it is even more uncommon to have spontaneous rupture of one! To briefly review, most hepatic cysts are simple or related to polycystic liver disease. Uncommon causes of hepatic cysts include hydatid (parasitic) cysts. Rare causes of hepatic cysts primary liver cancer and metastatic disease from other primaries.

If a hepatic cyst ruptures, it is usually due to trauma. The patient above vehemently denied any abdominal trauma. She also denied any violent coughing. There was a case report of a woman who ruptured a hepatic cyst after a coughing spell.

My patient was admitted and a surgical consultation was obtained. The opinion of the surgeon was that these cysts usually self-cauterize and stop bleeding on their own. My patient was hemodynamically stable and did not sustain a drop in her hemoglobin, so she was simply observed. The surgeon also said that if she did seem to re-bleed or become unstable, then the next step would be angiography to cauterize the cyst.

This patient continued to improve and did not require any intervention. It still remains a mystery as to why her cyst decided to rupture!