A 44-year-old female with an established diagnosis of autosomal dominant polycystic kidney disease (based on imaging findings and family history) was being evaluated for weight loss, early satiety and progressive abdominal distension. Kidney function had been relatively stable for years. Because of a history of multiple liver cysts on ultrasonography, the patient was referred for Gastroenterology for evaluation. Magnetic resonance imaging of the abdomen revealed a large number of kidney and liver cysts (the largest with 70mm of diameter), occupying a significant portion of the abdominal cavity and causing marked distension. This case illustrates the massive volume that can be reached by the growing cysts, which is the main cause of morbidity in this disease and for which novel and effective therapies are still needed.