Pancreatic Pseudocyst of the Mediastinum

Abstract

We present a case of a 61-year-old man with a history of pancreatitis, who presented at the emergency department with chest pain, vomiting, and dysphagia. His blood count, the levels of cardiac and liver enzymes and electrolytes, as well as the results of renal function tests were normal. An electrocardiogram revealed sinus rhythm without any changes of ischemia. Chest X-ray with contrast showed restriction in the distal esophagus without infiltration of the wall (FIGURE 1A). Endoscopy showed compression of the distal esophagus by an extrinsic mass (FIGURE 1B). Computed tomography (CT) scans of the back medi-astinum revealed a pseudocyst extending from the abdomen to the chest through the hiatus of the esophagus (FIGURE 1C). Endoscopic retro-grade cholangiopancreatography (ERCP) showed normal ductal anatomy. There was no communication between the pancreatic duct and the pseu-docyst (FIGURE 1D). Endosonography (EUS)-guided drainage of the mediastinal pancreatic pseudo-cyst was performed through the terminal esophagus using linear EUS. Two passes were made with a 19-gauge needle using a transesophageal approach, and 200 ml of serous amber fluid was removed (FIGURE 1E). High levels of amylase were observed in the fluid (15,774 U/l). Tumor markers were within normal ranges. A control CT scan did not confirm the cyst near gastroesophageal hernia, and there was no pathology in the back mediastinum (FIGURE 1F). Pancreatic pseudocysts are diagnosed accidentally in 20% of the patients and on autopsy in 24% of the patients. 1 A pseu-docyst occurs in 7% to 15% of the patients with FIGURE 1 AX ray imaging of the esophagus with contrast water; B-compression of the distal esophagus by an extrinsic mass in endoscopy; C-computed tomography scan showing a cystic mass extending from the border of the pancreatic body and tail into the mediastinum; D-no communication between the pancreatic duct and the pseudocyst on endoscopic retrograde cholangiopancreatography; E-endosonography-guided drainage of the mediastinal pancreatic pseudocyst through the terminal esophagus; F-computed tomography scan without a cystic mass in the mediastinum

Pleuropancreatic fistula: endoscopic retrograde cholangiopancreatography and computed tomography

“…In A barium esophagram obtained for dysphagia may exhibit anterior and/or lateral displacement of the esophagus [2,3]. Serial chest films for dyspnea will reveal pleural effusions [4].…”

Pancreatic Pseudocyst of the Mediastinum: Case Report and Review of the Literature

“…The latter finding may not occur if the retroperitoneal component of the cyst is relatively insignificant [9]. Ultrasound scan, though reported to be of some value [14,15], is of limited value in the chest and mediastinum. There were 3 reports prior to ours [21,22,23] in which CT scanning of the abdomen and chest have suggested the diagnosis, which was confirmed at operation in 2 of these cases [22,23] and in ours.…”

ITMIG Classification of Mediastinal Compartments and Multidisciplinary Approach to Mediastinal Masses

“…Pancreatic Pseudocyst.-A cystic mass in the paravertebral mediastinum that develops over a short period of time in the clinical setting of pancreatitis may represent intrathoracic extension of a pancreatic pseudocyst (74). These uncommon lesions contain pancreatic secretions, blood, and necrotic material and spread through the esophageal or aortic hiatus (69).…”