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Year : 2020  |  Volume : 20  |  Issue : 2  |  Page : 93-96

Cardiac compression of a hepatic cyst in polycystic liver disease: A rare cause of hemodynamic instability

1 Department of Emergency Medicine, University of Health Sciences Ümraniye Training and Research Hospital, Istanbul, Turkey
2 Department of Emergency Medicine, University of Health Sciences Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
3 Department of Emergency Medicine, Bahçeşehir University, Istanbul, Turkey
4 Department of Radiology, Biruni University, Istanbul, Turkey

Correspondence Address:
Dr. Serdar Özdemir
Department of Emergency Medicine, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2452-2473.279558

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

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