Acute mediastinal pancreatic fluid collection with pericardial and pleural effusion

Singh, Perminder; Holubka, Jacquelin; Patel, Shailesh

doi:10.1007/bf02093597

Cited by 10 publications

(5 citation statements)

References 13 publications

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“…The diagnosis should be made promptly, as suggested by current guidelines, by transthoracic echocardiography; this might be difficult in patients with mechanical ventilation;6 initial treatment remains the rapid resolution of haemodynamic deterioration by pericardiocentesis (class IA) 7. Pericardiocentesis should be performed in all patients with haemodynamic impairment demonstrated with clinical and echocardiographic signs such as pulsus paradoxus, Beck’s triad and transmitral flow variability >25% in pulsed Doppler; in addition to pericardiocentesis, there have been some case reports of patients treated with somatostatin8 or its analogue, octreotide acetate, especially in patients with chronic effusions 9. It should be noted that these novel medical treatments should never replace pericardiocentesis and have only been used as adjunctive therapy.…”

Section: Discussionmentioning

confidence: 99%

Cardiac tamponade, an unusual complication of acute pancreatitis

et al. 2016

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A 41-year-old Hispanic man was admitted to our hospital with the diagnosis of acute pancreatitis due to hypertriglyceridemia. During his stay, he developed sudden haemodynamic instability and clinical presentation suggestive of cardiac tamponade. A transthoracic echocardiogram confirmed the diagnosis. Echocardiography-guided pericardiocentesis was performed with immediate haemodynamic improvement. The patient's condition underwent favourable evolution. The pancreatitis was resolved and a control transthoracic echocardiography was performed showing no pericardial effusion. The pathophysiology of this rare entity is unknown. Early diagnosis and treatment are crucial. Although pericardiocentesis is the treatment of choice, there have been a few reports of medical treatment with encouraging results. Although the association of acute pancreatitis and tamponade are anecdotal in literature, medics should be aware of this association in order to perform prompt diagnosis.

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Section: Discussionmentioning

confidence: 99%

Cardiac tamponade, an unusual complication of acute pancreatitis

et al. 2016

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“…Despite the CTSI having been successfully used to predict overall mortality in patients with AP, Balthazar and others have confirmed that when using the CTSI there was no significant difference in mortality between patients who have 30–50% necrosis and patients who have more than 50% necrosis [7], [26]. Recent publications have confirmed that the mediastinal acute fluid collection in patients with AP can result in increased morbidity and mortality [27]. Furthermore, as a risk factor for severe AP, pleural effusion was included in the RCSI scoring system [28].…”

Section: Discussionmentioning

confidence: 99%

Retrocrural Space Involvement on Computed Tomography as a Predictor of Mortality and Disease Severity in Acute Pancreatitis

Ebner

Jiang

et al. 2014

PLoS ONE

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BackgroundBecause computed tomography (CT) has advantages for visualizing the manifestation of necrosis and local complications, a series of scoring systems based on CT manifestations have been developed for assessing the clinical outcomes of acute pancreatitis (AP), including the CT severity index (CTSI), modified CTSI, etc. Despite the internationally accepted CTSI having been successfully used to predict the overall mortality and disease severity of AP, recent literature has revealed the limitations of the CTSI. Using the Delphi method, we establish a new scoring system based on retrocrural space involvement (RCSI), and compared its effectiveness at evaluating the mortality and severity of AP with that of the CTSI.MethodsWe reviewed CT images of 257 patients with AP taken within 3–5 days of admission in 2012. The RCSI scoring system, which includes assessment of infectious conditions involving the retrocrural space and the adjacent pleural cavity, was established using the Delphi method. Two radiologists independently assessed the RCSI and CTSI scores. The predictive points of the RCSI and CTSI scoring systems in evaluating the mortality and severity of AP were estimated using receiver operating characteristic (ROC) curves.Principal FindingsThe RCSI score can accurately predict the mortality and disease severity. The area under the ROC curve for the RCSI versus CTSI score was 0.962±0.011 versus 0.900±0.021 for predicting the mortality, and 0.888±0.025 versus 0.904±0.020 for predicting the severity of AP. Applying ROC analysis to our data showed that a RCSI score of 4 was the best cutoff value, above which mortality could be identified.ConclusionThe Delphi method was innovatively adopted to establish a scoring system to predict the clinical outcome of AP. The RCSI scoring system can predict the mortality of AP better than the CTSI system, and the severity of AP equally as well.

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“…Also, the extension of proteolytic enzymes through the esophageal hiatus into the posterior mediastinum, in close proximity to the heart, the esophagus, and vital vascular structures, significantly increases the potential for life-threatening complications such as penetration of the pericardium or compression of the left atrium and ventricle resulting in a right ventricular pressure gradient [14]. …”

Section: Discussionmentioning

confidence: 99%

An Unusual Case of Ascending Pancreatitis with Mediastinal Involvement: A Case Report with CT and MRI Findings

Cesare

Sibio

Gennarelli

et al. 2014

Case Reports in Radiology

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Fluid collections are common findings of pancreatitis and spread, more often, along preferential drainage pathways in the abdomen. In some rare cases, fluid collections may spread towards extra-abdominal sites like the mediastinum leading to the formation of mediastinal collections. We present the case of a 52-years-old man with pain in the right upper quadrant of the abdomen and mid-epigastrium lasting for some hours. Laboratory tests suggested a diagnosis of pancreatitis. CT and subsequent MRI revealed changes consistent with acute exacerbation on chronic pancreatitis spreading to the mediastinum and to the greater omentum. The patient received medical treatment and reported gradual improvement in his laboratory results and CT findings.

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Acute mediastinal pancreatic fluid collection with pericardial and pleural effusion

Cited by 10 publications

References 13 publications

Cardiac tamponade, an unusual complication of acute pancreatitis

Cardiac tamponade, an unusual complication of acute pancreatitis

Retrocrural Space Involvement on Computed Tomography as a Predictor of Mortality and Disease Severity in Acute Pancreatitis

An Unusual Case of Ascending Pancreatitis with Mediastinal Involvement: A Case Report with CT and MRI Findings

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