Algın Abdullah, Özdemir Serdar, Sarıaydın Mehmet, Erdoğan Mehmet Özgür, Inan Ibrahim
Department of Emergency Medicine, University of Health Sciences Ümraniye Training and Research Hospital, Istanbul, Turkey.
Department of Emergency Medicine, University of Health Sciences Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey.
Turk J Emerg Med. 2020 Feb 26;20(2):93-96. doi: 10.4103/2452-2473.279558. eCollection 2020 Apr-Jun.
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.
多囊肝（PLD）是由于肝内胆管的胚胎导管板畸形发展而来。肝脏中的囊肿可从简单的压迫效应到严重的肝功能衰竭。最常见的并发症是囊肿破裂和炎症。有时它会发展到将心脏推向左侧或压迫下腔静脉的程度，从而减少静脉回流。在此，我们报告一例患有巨大肝囊肿相关症状并导致右心室和右心房外部受压的病例。一名71岁女性患者因呼吸困难、胸痛和腹胀加重入住我院急诊科。她的生命体征如下：体温38°C，脉搏140次/分钟，血压70/40 mmHg。她的腹部膨隆，上腹部有轻微压痛。肝脏也肿大。胸部后前位X线片显示右下胸部有模糊影，使右膈轮廓消失。在胸腹部计算机断层扫描中，由于肝右叶一个大的囊性结构的压迫，心脏向左移位，将膈肌向上推。开始使用哌拉西林/他唑巴坦3 g×4.5 g进行治疗，并通过介入放射学进行外部引流。在此操作后，观察到患者病情有显著改善。她的症状明显改善，引流导管在第7天拔除。PLD患者的肝囊肿可能压迫相邻结构，如果发生血流动力学不稳定，心脏受压可能危及生命。
