The n e w e ng l a n d j o u r na l of m e dic i n e

Images in Clinical Medicine

Chana A. Sacks, M.D., Editor

Liver Involvement in Autosomal Dominant

Polycystic Kidney Disease

Mehmet E. Adin, M.D.

Tatvan Can Hospital
Bitlis, Turkey
emin​.­adin@​­gmail​.­com

A 
51-year-old woman with autosomal dominant polycystic kidney disease presented to the
primary care clinic with mild worsening of chronic abdominal pain. No jaundice was found on physical
examination; the liver was enlarged, and the patient had mild tenderness in the right upper quadrant and in
the flanks on both sides. Murphy’s sign was absent. Laboratory studies showed mildly elevated levels of aspartate
aminotransferase and alanine aminotransferase. Innumerable cysts were found on abdominal ultrasonography; the
gallbladder could not be visualized. Magnetic resonance cholangiopancreatography was performed and revealed a
markedly enlarged liver with numerous cystic structures (a three-dimensional maximum-intensity-projection recon-
struction is shown in the figure). No signs of intracystic hemorrhage, rupture, or infection were found; the presen-
tation was not consistent with acute cholecystitis. In autosomal dominant polycystic kidney disease, cysts can de-
velop in a range of sites, including the liver, pancreas, and seminal vesicles. The patient was treated with intravenous
hydration and analgesia, and the pain decreased. At a 1-year follow-up visit, no additional complications or new
symptoms had developed. The patient continued to have occasional abdominal pain.
DOI: 10.1056/NEJMicm1809242
Copyright © 2019 Massachusetts Medical Society.

1954 n engl j med 380;20 nejm.org  May 16, 2019

The New England Journal of Medicine

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