Hepatic Cyst: An Unusual Suspect of Syncope
The patient is a 75-year-old man with history of diabetes and hypertension who presented with syncope after experiencing sharp, 10/10 right flank and abdominal pain worsening over three weeks associated with decreased appetite. Physical examination revealed hepatomegaly and right lower quadrant (RUQ...
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| Format: | Article |
| Language: | English |
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Wiley
2020-01-01
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| Series: | Case Reports in Hepatology |
| Online Access: | http://dx.doi.org/10.1155/2020/1659718 |
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| author | Mohammad K. Choudhry Bei Xiong Antony Anandaraj John Trillo |
| author_facet | Mohammad K. Choudhry Bei Xiong Antony Anandaraj John Trillo |
| author_sort | Mohammad K. Choudhry |
| collection | DOAJ |
| description | The patient is a 75-year-old man with history of diabetes and hypertension who presented with syncope after experiencing sharp, 10/10 right flank and abdominal pain worsening over three weeks associated with decreased appetite. Physical examination revealed hepatomegaly and right lower quadrant (RUQ) tenderness, negative for peritoneal signs. Bloodwork showed leukocytosis (13 K/mcl), alkaline phosphatase (141 U/L), total bilirubin (2.0 mg/dL), and gamma-glutamyl transferase (172 U/L). Computed Tomography (CT) revealed multiple hepatic cysts with the largest measuring 17 × 14 × 18 cm (Figure 1). Parenteral opiates provided minimal relief. Cardiac and neurologic etiologies of syncope were ruled out. The patient’s course was complicated by opioid-induced delirium as his abdominal pain progressively worsened despite escalating doses of parenteral and oral analgesics. Gastroenterology and interventional radiology consulted to evaluate for Glisson’s capsular stretch. Therapeutic aspiration yielded 2.5 L of serous fluid, which alleviated the patient’s pain. Cytology was negative for malignancy. Opiates were titrated down. Repeat CT (Figure 2) showed cysts that were significantly reduced in size. The patient showed complete resolution of symptoms and was subsequently discharged. We present a rare case of a large hepatic cyst causing syncope. In the appropriate clinical setting, syncope with RUQ tenderness and hepatomegaly should raise the index of suspicion for hepatic cysts. |
| format | Article |
| id | doaj-art-37d171aa64c64eb9b5791fc90c0705e6 |
| institution | OA Journals |
| issn | 2090-6587 2090-6595 |
| language | English |
| publishDate | 2020-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Hepatology |
| spelling | doaj-art-37d171aa64c64eb9b5791fc90c0705e62025-08-20T02:07:59ZengWileyCase Reports in Hepatology2090-65872090-65952020-01-01202010.1155/2020/16597181659718Hepatic Cyst: An Unusual Suspect of SyncopeMohammad K. Choudhry0Bei Xiong1Antony Anandaraj2John Trillo3Department of Gastroenterology, NYCHH-Coney Island Hospital, Brooklyn, NY, USADepartment of Medicine, NYCHHC-Coney Island Hospital, Brooklyn, NY, USADepartment of Medicine, NYCHHC-Coney Island Hospital, Brooklyn, NY, USADepartment of Gastroenterology, NYCHH-Coney Island Hospital, Brooklyn, NY, USAThe patient is a 75-year-old man with history of diabetes and hypertension who presented with syncope after experiencing sharp, 10/10 right flank and abdominal pain worsening over three weeks associated with decreased appetite. Physical examination revealed hepatomegaly and right lower quadrant (RUQ) tenderness, negative for peritoneal signs. Bloodwork showed leukocytosis (13 K/mcl), alkaline phosphatase (141 U/L), total bilirubin (2.0 mg/dL), and gamma-glutamyl transferase (172 U/L). Computed Tomography (CT) revealed multiple hepatic cysts with the largest measuring 17 × 14 × 18 cm (Figure 1). Parenteral opiates provided minimal relief. Cardiac and neurologic etiologies of syncope were ruled out. The patient’s course was complicated by opioid-induced delirium as his abdominal pain progressively worsened despite escalating doses of parenteral and oral analgesics. Gastroenterology and interventional radiology consulted to evaluate for Glisson’s capsular stretch. Therapeutic aspiration yielded 2.5 L of serous fluid, which alleviated the patient’s pain. Cytology was negative for malignancy. Opiates were titrated down. Repeat CT (Figure 2) showed cysts that were significantly reduced in size. The patient showed complete resolution of symptoms and was subsequently discharged. We present a rare case of a large hepatic cyst causing syncope. In the appropriate clinical setting, syncope with RUQ tenderness and hepatomegaly should raise the index of suspicion for hepatic cysts.http://dx.doi.org/10.1155/2020/1659718 |
| spellingShingle | Mohammad K. Choudhry Bei Xiong Antony Anandaraj John Trillo Hepatic Cyst: An Unusual Suspect of Syncope Case Reports in Hepatology |
| title | Hepatic Cyst: An Unusual Suspect of Syncope |
| title_full | Hepatic Cyst: An Unusual Suspect of Syncope |
| title_fullStr | Hepatic Cyst: An Unusual Suspect of Syncope |
| title_full_unstemmed | Hepatic Cyst: An Unusual Suspect of Syncope |
| title_short | Hepatic Cyst: An Unusual Suspect of Syncope |
| title_sort | hepatic cyst an unusual suspect of syncope |
| url | http://dx.doi.org/10.1155/2020/1659718 |
| work_keys_str_mv | AT mohammadkchoudhry hepaticcystanunusualsuspectofsyncope AT beixiong hepaticcystanunusualsuspectofsyncope AT antonyanandaraj hepaticcystanunusualsuspectofsyncope AT johntrillo hepaticcystanunusualsuspectofsyncope |