Q. What does acute cholecystitis with multiple cysts in MRI indicate?

Answered by
Dr. A V Hussain Shihaz
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Feb 20, 2019

Hello doctor,

I have recently had an MRI and ultrasound scan for acute cholecystitis and they showed multiple cysts and a 16 cm x 12 cm cyst in my liver. Please could you tell me is that large for a cyst as I have been told it needs further surveillance. It is showing two benign looking hepatic cysts.



Welcome to icliniq.com.

A 16 cm cyst is a bit large cyst. A few more details about your condition would be quite informative. Have you ever had any pain in the abdomen or jaundice in the past? Any contact with sheep, any pet dog? Kindly inform what was the management for acute cholecystitis, was cholecystectomy done or just managed with antibiotics and other medicines? If it is possible to upload the images or reports of the ultrasound and MRI, it would be really helpful to give a comprehensive opinion.

Thank you doctor,

I have had pain that comes and goes in my abdomen but no jaundice. I had a dog for 13 years. I am waiting for an appointment to see a member of the Gastroenterology team at my local hospital for a cholecystectomy and a Hepatologist for the liver cysts. The acute cholecystitis was managed in the hospital for five days on intravenous antibiotics and other medicines, but the consultant said I will need a cholecystectomy and surveillance follow up on cysts. Also, I thought the gallbladder removal and the cysts could be dealt with by the gastroenterology team at the same time, is that correct? Or is it two different teams? I do not have the scanned pictures. Would the large cyst on the liver help if it is to be removed or deroofed as they say in the medical terms? As the cyst is 16 cm x 12 cm would they remove it as it is causing some discomfort or will they just leave it? Also, please could you explain the lab blood WCC 12.9 and CRP 18.7. What do they mean?



Welcome back to icliniq.com.

Laparoscopic cholecystectomy would be done by the upper GI surgery team and the cyst follow-ups would be done by the Gastroenterology or Hepatology team. The chances of the cysts being a simple cyst are high, but an MRI would have given very valuable information. If the consultant has said that you would need cholecystectomy and surveillance follow up of the cyst, it most probably is a benign one. Deroofing of asymptomatic simple cysts are not usually done unless there is suspicion of something else.

Usually, if symptomatic, the cysts are removed or deroofed. Your symptoms cannot be positively attributed to the presence of liver cysts because gall bladder stones could also precipitate similar symptoms. The removal or deroofing of cysts would also be determined by the location of the cyst in the liver, hence the relevance of an MRI report. The raised white cell count and CRP is mostly due to cholecystitis (though I am unaware of the temporal relation of your blood tests with cholecystitis).

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