A 65-year-old man was referred to the Gastroenterology Department with complaints of longstanding upper abdominal discomfort and hepatomegaly. Ultrasound of the liver revealed a massively enlarged liver with multiple cystic areas. Aspiration of the largest cyst revealed 15 ml of yellow fluid without any organisms or malignant cells.A diagnosis of autosomal- dominant polycystic kidney disease was suspected, but could not initially be confirmed on ultrasound/ computed tomography imaging. Magnetic resonance imaging confirmed the multiple hepatic cysts and revealed multiple smaller cysts in both kidneys. Symptomatology subsided after aspiration of the largest cyst and the patient was discharged. The patient has subsequently been followed up and is currently symptom free. The case illustrates the importance of screening for associated kidney disease in patients with polycystic liver disease.

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