Case 5

This is an MRI liver study showing a large cystic mass in the liver with thin walls – it shows a macrocystic appearance with multiple large cysts separated by septations. The septations show faint enhancement on the post gadolinium series.

I note that there is no evidence of bleeding on the SWI series, and the fluid contents appear simple with no blood products or thick proteinaceous material.

These features, when considering the age of the patient, point to a diagnosis of cystic hepatic mesenchymal hamartoma.

The differential diagnosis includes undifferentiated embryonal sarcoma of the liver; however, this typically has thicker septations, larger solid components, and presents in older children. Biliary cystadenomas may share these features, but are seen in adults. Simple hepatic cysts are typically unilocular and don’t enhance.