the majority of the congenital solitary nonparasitic cysts of the liver ( csncls ) are found in adults , are asymptomatic and detected incidentally at autopsy or laparotomy . a 3-day - old male neonate delivered vaginally at 34 weeks of gestation was brought with progressive abdominal distension since birth . maternal ( antenatal ) history was not contributory . clinical photograph of the neonate showing massively distended abdomen erect x - ray abdomen showed bowel loops displaced to left hypochondrium . ultrasonography of the abdomen showed a solitary , large cystic lesion 9.7 cm  6 cm  9.4 cm in size , incumbent on the left and right lobes of liver extending from the epigastrium to the pelvis . . computerized tomography scan of the abdomen was not done since the child 's condition was quite unstable . on exploration , a huge , unilocular , thin - walled , transparent cyst almost prolapsed out [ figure 2 ] . growing extrahepatically , it was displacing them on either side and had completely replaced the falciform ligament and the ligamentum teres . enucleation of the cyst along with marsupialization of the portion within liver parenchyma was done . fluid cytology showed the presence of albumin ; but no bile salts , pigments or urobilinogen . the baby was stable for 36 h postoperatively . however , thereafter he succumbed to death . the histopathology of the excised cyst showed the cyst wall composed of loose connective tissue with many thin - walled dilated blood vessels , few clusters of lymphocytes , and bile ducts . the cyst wall was lined by columnar epithelium , and there was sparse mononuclear cell infiltrate ; suggestive of a csncl . different reports describe this entity using various names such as simple liver cysts , congenital hepatic cysts , solitary nonparasitic cysts of liver , congenital solitary liver cysts , and csncl . this could be because of the rarity of the lesion and calls for uniform nomenclature worldwide in order to know the exact incidence of these cysts . the term solitary cyst refers to unilocular cysts that are typically single and are unassociated with cysts in other organs . studies indicate that these cysts arise from congenital or secondary obstruction of the peribiliary glands , which normally arise from the ductal plate at the hepatic hilum around 7 week of gestation and continue to proliferate until adolescence . persistence of small remnants of the ductal plate malformation ( von meyenburg complexes ) that separate out from the biliary tree and become dilated are supposed to give rise to csncls . they are generally lined by a single layer of cuboidal or columnar epithelium , characteristic of the bile ducts . most cysts are superficially located just under the liver capsule , although they may be found in the falciform ligament . the majority of them are asymptomatic and are managed by simple unroofing , marsupialization , sclerotherapy or laparoscopic fenestration . stehr and guzzetta have described csncls to be rare and occurring more commonly in adults than in children . they have observed males and females being equally affected , whereas few other authors have reported female preponderance . quillin and mcalister , chatterjee et al . have presented isolated cases of neonates and infants of csncl detected antenatally and managed successfully in the postnatal period . rygl et al . have reported review of six children ( four girls and two boys ) with congenital solitary liver cysts . the age range in their series was from the neonatal period to 14 years . in our case , there was a unilocular , thin - walled , transparent cyst of 15 cm  12 cm  12 cm in size . it originated between the right and left lobes of the liver and was overhanging both the lobes . growing extrahepatically , it was displacing them on either side and had completely replaced the falciform ligament and the ligamentum teres . the absence of the falciform ligament and remnants of the ligamentum teres also assert its congenital origin . in this neonate , hence , the decision was taken to explore the child . in most of the reports have described ultrasonography to be conclusive for diagnosis of csncl in children . in our case , though cyst in relation to the liver was detected on ultrasonography , the diagnosis of csncl was totally unsuspected . rygl et al . have reported the presence of columnar epithelial lining in newborns ; whereas atrophic changes were found in the lining epithelium in older children . they also found the presence of metaplastic squamous epithelium with dysplastic foci in the lining epithelium in a 13-year - old girl . hence , surgical therapy should be undertaken , even though , the child is asymptomatic . the differential diagnosis of the abdominal cystic lesion in neonates includes mesenteric cyst , duplication cyst , hepatoblastoma , teratoma , lymphangioma , choledochal cyst , and renal cyst . though rare , csncls should also be considered as differential diagnosis , especially in cases of cystic masses in the proximity of the liver . acute surgical crisis in neonatal period occurs because of diaphragmatic splinting and respiratory embarrassment caused by giant csncl as in our 's , and early relief of the same might be life - saving . if widely known , simple ultrasonography - guided aspiration of these cysts in unstable neonates may prevent unnecessary laparotomy in unprepared emergency situations and salvage the neonate . the authors certify that they have obtained all appropriate patient consent forms . in the form the patient(s ) has / have given his / her / their consent for his / her / their images and other clinical information to be reported in the journal . the patients understand that their names and initials will not be published and due efforts will be made to conceal their identity , but anonymity can not be guaranteed . the authors certify that they have obtained all appropriate patient consent forms . in the form the patient(s ) has / have given his / her / their consent for his / her / their images and other clinical information to be reported in the journal . the patients understand that their names and initials will not be published and due efforts will be made to conceal their identity , but anonymity can not be guaranteed .
a 3-day - old male neonate delivered at 34 weeks of gestational age was brought with breathing difficulty since birth . 
 the abdomen was massively distended . 
 a soft cystic mass was occupying almost the entire abdomen and causing obvious respiratory distress . on exploration , a huge , solitary , unilocular cyst was found between the two lobes of the liver . 
 growing extrahepatically between the two lobes , it had displaced them laterally on either side . 
 enucleation of the cyst and marsupialization of its base was done . 
 histopathology showed evidence of congenital solitary nonparasitic cyst of the liver . 
 symptomatic presentation of csncl in children , especially in a neonate is extremely rare and not considered as a differential diagnosis of an abdominal mass . 
 hence , the case report .