A 70-year-old man could provide no personal or family medical history. He sought medical attention for abdominal distension and symmetrical non-gravitational lower limb edema that he had presented with for many years, accompanied with anorexia and early satiety. Physical examination revealed protein-caloric malnutrition and jaundice of the skin and mucosae. There was a large, hard, non-painful, polylobular abdominal tumor in the right hypochondrium. The lower limbs presented with edema extending to the upper thigh that was nonpainful, with no fluxive signs. Abdominal computed tomography (CT) scan identified heterogeneous hepatomegaly and plain-looking multiple cysts substituting almost the entire parenchyma. One of them was compressing the vena cava and another had a hemorrhagic content. There were no elements of portal hypertension. The kidneys were normal. Medical treatment with nutritional support and diuretics was given. Liver transplantation or partial hepatic resection were not considered due to the patient's poor general status. A CT-guided transparietal puncture was carried out on the 2 largest cysts, draining a total of 600 cc, and alcohol instillation was done. The patient progressed well, with reduced edema and improved appetite and nutritional status (Figs. 1 and 2).

Figure 1.

Multiple hepatic cysts, one of which was hemorrhagic.

Figure 2.

Diffuse hepatic involvement not affecting the kidneys.