Foam sclerotherapy for a symptomatic hepatic cyst: a preliminary report

Abstract

Purpose: We evaluated our initial experience of performing sclerotherapy for symptomatic hepatic cysts using polidocanol foam instead of a liquid sclerosant.

Methods: Three consecutively registered patients with symptomatic hepatic cysts (one with polycystic liver disease) underwent polidocanol foam sclerotherapy. A pigtail catheter was inserted into the targeted cyst following percutaneous cyst puncture under ultrasound guidance, and the cyst fluid was aspirated. To confirm the absence of communications between the cyst and surrounding hepatic vessels, 3 % polidocanol foam sclerosant was injected at a 1:4 ratio of polidocanol to air following digital subtraction cystography with carbon dioxide. C-arm computed tomography (CT) guidance also was used to monitor foam filling of the targeted cyst. The maximum dose of sclerosant injected per treatment session did not exceed 10 ml. The catheter was kept unclamped overnight for open drainage, and additional sclerotherapy sessions were performed on subsequent days, if needed.

Results: Efficient sclerotherapy was achieved with an average of two sessions. The initial mean cyst volume was 1,052 ml, and gradual resolution was observed without recurrence. The mean reduction rate was 97.9 % (97.7-98.3 %), and all cyst-associated symptoms disappeared. The median follow-up period was 17 (range 6-21) months. Although one patient experienced moderate-grade fever and another moderate pain at the puncture site, no major complications were observed.

Conclusion: Polidocanol foam sclerotherapy is a safe and effective treatment for symptomatic hepatic cysts.

Fig. 1

A 67-year-old woman (Case 1) with a symptomatic hepatic cyst causing abdominal distension. CT scan (arrow, A) shows a huge cyst in the right lobe of the liver, which is depicted as a well-demarcated cystic mass with several septums projecting to the right diaphragm on a coronal T2-weighted magnetic resonance image (arrow, B). While the patient was in a prone position, 10 ml of polidocanol foam was injected under fluoroscopy (D) through a pigtail catheter (arrow, C, D) placed in the cyst. This was performed after digital subtraction cystography (C) with 10 ml of CO₂ in the same position. The distribution of the foam sclerosant was almost identical to that of CO_2, without any evidence of migration to the systemic circulation or surrounding hepatic vessels. E Axial reformation C-arm CT images depict the foam sclerosant as air density area distributed on the upper side within the cyst without any mixture or dilution and with a small amount of residual cyst fluid (asterisk) after percutaneous aspiration in the supine position. Note the pigtail catheter in the targeted cyst (arrowheads). F CT performed 6 months after sclerotherapy showing that the cyst was remarkably reduced in size (arrow)