A CT scan showed I have what may be a cyst on the liver. I have had right side pain for years and it's all been written off to OB-GYN problems. Because of all the uncertainty about my condition, I have also been suffering from periods of anxiety. My HMO doctor seems to only be concerned about the anxiety and did not even order any more liver tests. What do you think?

D.C.

Patients who suffer from abdominal discomfort or pain often undergo an ultrasound and/or CT scan to evaluate this complaint. In many cases, the cause of the symptoms is found by the imaging exam. In other cases, the problem is not found and other tests must be done to pinpoint the source of the symptoms. Finally, in a few cases, abnormalities may be found that are probably not the cause of the patient's pain. Liver cysts frequently fall into this category.

In most cases, liver cysts are benign and do not cause pain or other symptoms. However, in rare cases, patients may experience pain due to liver cysts that are infected or malignant. Also, even benign cysts can cause pain or discomfort in the right side of the abdomen when they grow to large sizes or if they spontaneously bleed internally.

Doctors should evaluate your pain in relation to the location of the possible liver cyst to determine whether there may be a connection. Other symptoms such as fever, vomiting or jaundice might also provide clues. Blood tests could be done to check for elevated levels of liver enzymes. If there is still uncertainty, then further tests (such as MRI or a liver biopsy) might be needed.

You should follow up with a gastroenterologist experienced in liver disease for more definitive evaluation. Still, remember that most patients who have small liver cysts on CT scans have no symptoms as a result of these cysts.