Polycystic Liver and Kidney Disease

A 54-year-old African American woman who had not received medical care for 20 years presented to establish care with a primary care provider. She complained of slowly progressive abdominal distention and early satiety, which she had attributed to weight gain from her sedentary lifestyle. On examination, she had a firm, protuberant nontender abdomen. Laboratory results and urinalysis were unremarkable. Computed tomography of the abdomen and pelvis with contrast (Figures A and B) noted innumerable large cysts of her liver (white arrow) and kidneys (red arrows) consistent with polycystic kidney and liver disease. She was referred to gastroenterology for assistance with management. Polycystic liver disease is the most common extrarenal manifestation of autosomal-dominant polycystic kidney disease. The prevalence of liver cysts in autosomal-dominant polycystic kidney disease increases with age, from about 10% in those younger than age 30 years to greater than 70% in persons older than age 60. Possible cyst complications include cyst infection, hemorrhage, and torsion. Biliary and hepatic venous outflow obstruction, or progressive liver or kidney dysfunction requiring transplantation may also occur. No immediate cyst complications were identified in our patient and she continues routine outpatient follow-up. Informed consent was obtained from the patient prior to article submission.