The Ciliated Hepatic Foregut Cyst

INTRODUCTIONThe ciliated hepatic foregut cyst (CHFC) is a rare benign cystic lesion of the liver. Since its initial description fewer than one hundred cases have been reported in the literature.CHFCs are usually asymptomatic and often discovered incidentally during imaging for other reasons. They are most often located in the anterior subcapsular region of segment IV of the liver. The definitive diagnosis is histopathological. CASE REPORT We report the case of a 60-year-old man with no significant medical or surgical history who underwent a thoraco-abdomino-pelvic CT scan as part of the workup for a pathological fracture of the left femur. It revealed an oval, well-circumscribed cystic lesion in the anterior subcapsular region of segment IVa. US and MRI were used for further assessment. DISCUSSION CHFCs are rare cystic liver lesions resulting from abnormal embryonic development. Although benign, rare cases of malignant transformation have been reported . They typically occur in adults between 50 and 55 years, and a slight male predominance. Most cases are asymptomatic. They are characteristically located in the anterior subcapsular region of segment IV —a key diagnostic clue. Ultrasound, is usually the first-line modality. It reveals a well-defined unilocular cyst with dependent echogenic sediment. CT typically shows a spontaneously hypodense lesion without post-contrast enhancement. MRI is the gold standard for lesion characterization. It reveals the pathognomonic “smurf’s head” appearance, as seen in our case. Histological confirmation is recommended. Management remains controversial as CHFC is not purely benign due to its malignant transformation potential. CONCLUSION CHFC is a rare benign liver lesion that should be considered in any middle-aged adult presenting with a unilocular cystic lesion in segment IV.