Bleeding into a liver cyst can be treated conservatively.

Objective: To report the case of a patient with haemorrhage in a large hepatic cyst.

Patient: A 66-year-old man, who presented with right shoulder pain and subsequent sudden abdominal pain. A large hepatic cyst containing blood was found at ultrasonography.

Interventions: The patient was treated conservatively.

Results: The patient's symptoms resolved quickly. No symptoms or complications recurred during a follow-up of 2 years.

Conclusion: Therapy for non-parasitic liver cysts is indicated when symptoms or complications related to the cysts occur. This case shows that spontaneous haemorrhage into a non-parasitic hepatic cyst may follow a benign course and may be treated conservatively.