# A Massive Liver Cyst Mimicking Decompensated Heart Failure: A Diagnostic Pitfall

## TL;DR

A large liver cyst mimicked heart failure symptoms, but was successfully treated with drainage.

## Contribution

Highlights a rare diagnostic challenge of a massive hepatic cyst mimicking heart failure.

## Key findings

- A massive hepatic cyst caused severe right heart compression and acute kidney injury.
- Percutaneous drainage rapidly improved hemodynamics and renal function.
- The case emphasizes the importance of considering hepatic cysts in atypical presentations.

## Abstract

Simple hepatic cysts are common benign liver lesions that are typically asymptomatic. Although complications such as intracystic hemorrhage or rupture may occur, they are rare. Mass effect is more likely to be seen in cases of markedly enlarged cysts, which may compress adjacent organs and lead to atypical clinical presentations. We report a rare case of a massive hepatic cyst causing severe external compression of the right heart, resulting in hypotension, oliguric acute kidney injury, and critical limb ischemia. Percutaneous drainage of the cyst led to immediate hemodynamic improvement, with rapid resolution of hypotension and dramatic recovery of renal function and urine output. This case highlights an unusual presentation of a giant hepatic cyst, discusses the associated diagnostic challenges, and reviews important considerations in its evaluation and management.