1 Introduction
Primary cystic hepatobiliary neoplasm is a rare entity that can be benign and malignant.1 The overall risk of malignant transformation or even harboring malignancy warrants careful evaluation and timely management of these cysts. Biliary cystadenoma/ mucinous cystic neoplasm and intraductal papillary mucinous neoplasm of bile duct (IPMN-B) are two broad categories of benign/premalignant cysts.1 Cystic IPMN-B is a recently described distinct entity occurring exclusively in intrahepatic bile ducts. The risk of malignant transformation is 64% to 89% compared to 2% to 30 % in biliary cystadenoma.1 However, making the clinical diagnosis of these cysts is a diagnostic challenge. We present a unique case of cystic IPMN-B of the left lobe of the liver with associated liver atrophy in an elderly lady.