Cardiac compression of a hepatic cyst\rin polycystic liver disease: A rare cause\rof hemodynamic instability

Abstract

Polycystic liver disease (PLD) develops due to embryonic ductal plate malformation of intrahepatic\rbile ducts. Cysts in the liver can range from a simple compression effect to severe liver failure. The\rmost common complication is rupture and inflammation of cyst. It can sometimes progress to the\rextent of pushing the heart to the left or compressing the inferior vena cava, thereby reducing the\rvenous return. Here, we present a case with giant liver cyst-related symptoms that caused external\rcompression of the right ventricle and atrium. A 71-year-old female patient was admitted to our\remergency department with increasing dyspnea, chest pain, and abdominal distension. Her vital\rsigns were as follows: temperature 38°C, pulse 140 beats/min, and blood pressure 70/40 mmHg.\rHer abdomen was distended, and there was minimal epigastric tenderness. Hepatomegaly was also\rpresent. Posteroanterior chest radiography revealed opacity that erased the right diaphragm contour\rat the right inferior hemithorax. In thoracoabdominal computed tomography, the heart was deviated\rtoward the left due to the compression of a large cystic formation located in the hepatic right lobe,\rpushing the diaphragm to the superior. Piperacillin/tazobactam 3 g × 4.5 g treatment was initiated,\rand external drainage was performed by interventional radiology. Following this procedure, significant\rimprovement was observed in the patient’s condition. Her symptoms significantly improved, and the\rdrainage catheter was removed on the seventh day. Hepatic cysts in patients with PLD may compress\radjacent structures, and cardiac compression can be life-threatening if hemodynamic instability occurs.\r