Simple Hepatic Cysts as Markers of Thoracic Aortic Disease

Research Article

J Dis Markers. 2021; 6(1): 1043.

Simple Hepatic Cysts as Markers of Thoracic Aortic Disease

Kim C¹, Ziganshin BA², Zafar MA², Buntin J² and Elefteriades J²*

¹Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, United States of America

²Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut, United States of America

*Corresponding author: John Elefteriades, Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut, United States of America

Received: June 08, 2021; Accepted: June 29, 2021; Published: July 06, 2021


Objective: Thoracic Aortic Disease (TAD) is potentially lethal, yet difficult to detect as most patients are asymptomatic until the aneurysm dissects and becomes life threatening. Several clinical markers for TAD have been identified such as: bicuspid aortic valve, intracranial aortic aneurysm, bovine aortic arch, positive family history, and simple renal cysts. The aim of this study was to investigate the prevalence of Simple Hepatic Cysts (SHC) among individuals diagnosed with TAD in order to assess whether they can be used as a predictor of TAD.

Methods: In this retrospective study, the prevalence of SHC for (n=1244) hospital patients treated for TAD was evaluated and compared to a control group of (n=809) patients. TAD patients were divided into four subgroups: ascending aneurysm (788; 63.3%; descending aneurysm (123; 9.9%); type A dissection (137; 11%); type B dissection (196; 15.8%). The presence of SHC was determined based on either computed tomography, magnetic resonance imaging, or ultrasound imaging of these patients.

Results: Prevalence of SHC was 14.8%, 11.4%, 12.4%, and 14.8% in patients with ascending aneurysm, descending aneurysm, type A dissection, and type B dissection, respectively. Prevalence of SHC in the control group was 3.8% (p<0.001). The prevalence of SHC was not significantly different between males and females among the TAD patients as well as the control population.

Conclusion: Individuals with TAD have an increased prevalence of SHC compared to individuals without TAD. SHC can potentially be used as a clinical marker to detect patients at risk for TAD.

Keywords: Hepatic cysts; Thoracic aortic disease; Aortic aneurysms; Aortic dissections


SHC: Simple Hepatic Cysts; TAD: Thoracic Aortic Disease; TAA: Thoracic Aortic Aneurysms; PCLD: Polycystic Liver Disease; CT: Computerized Tomography; US: Ultrasound; MRI: Magnetic Resonance Imaging


According to the most recent statistics from the Centers for Disease Control and Prevention, aortic aneurysm and dissection has been responsible for taking the lives of more than 110,000 individuals in all age groups annually in the last decade [1]. Ruptured aortic aneurysms have almost a 90% mortality rate, and aneurysm disease is the 15th most common cause of death for individuals aged 65 and over [2]. The incidence of Thoracic Aortic Aneurysms (TAA) is estimated to be at least 5-10 per 100,000 person-years; surprisingly, TAD causes more deaths than the Human Immunodeficiency Virus (HIV) [3,4]. Death from acute aortic dissection often causes pre-hospital sudden death, yet its incidence is grossly underestimated with reports estimating that about 50% of type A dissections remain undetected as it resembles other disorders such as myocardial infarction [5]. Recent studies have reported a staggering 7% of all sudden deaths in the outof- hospital cardiopulmonary arrest due to type A dissection [6].

Given the lethality of thoracic aortic aneurysms, a timely detection and application of surgical therapy is critical. However, detection is often difficult given that only 5% of thoracic aortic aneurysms are symptomatic, the majority of which are diagnosed minutes before death-earning TAA the appropriate nickname of being a ‘silent killer’ [7]. Fortunately, recent studies have identified clinical markers, or ‘associates’ of TAA that can detect individuals at risk of having or developing an aneurysm in their chest. Such guilty suspects that have been associated with Thoracic Aortic Disease (TAD) include intracranial aneurysms, bovine aortic arch, bicuspid aortic valve, a family history of thoracic aortic disease, and renal cysts [7].

A “Simple Hepatic Cyst” (SHC) refers to a solitary, benign, and non-parasitic cyst of the liver that may contain a clear yellow fluid [8]. These are thought to arise due to abnormal development of congenitally aberrant intrahepatic bile ducts that slowly dilate later in life [8]. Most SHC are rarely symptomatic and do not require immediate clinical attention: 80% to 95% of hepatic cysts have reported to remain asymptomatic until an acute event such as upper abdominal pain, rupture, infection, or hemorrhage [9]. Several autopsy and imaging-based studies have tried to evaluate the prevalence of SHC in the general population, with great variability in results. Estimates of hepatic cyst prevalence have been reported to be as low as 0.1% or to be as high as 29%, largely depending on factors such as the imaging modality and population studied (Table 1). The majority of the literature reports higher prevalence rates of SHC among females (Table 1). The prevalence of SHC also increases with age [8].