A Massive Liver Cyst Mimicking Decompensated Heart Failure: A Diagnostic Pitfall

Simple hepatic cysts are common benign liver lesions that are typically asymptomatic. Although complications such as intracystic hemorrhage or rupture may occur, they are rare. Mass effect is more likely to be seen in cases of markedly enlarged cysts, which may compress adjacent organs and lead to atypical clinical presentations. We report a rare case of a massive hepatic cyst causing severe external compression of the right heart, resulting in hypotension, oliguric acute kidney injury, and critical limb ischemia. Percutaneous drainage of the cyst led to immediate hemodynamic improvement, with rapid resolution of hypotension and dramatic recovery of renal function and urine output. This case highlights an unusual presentation of a giant hepatic cyst, discusses the associated diagnostic challenges, and reviews important considerations in its evaluation and management.