Fig 3 - available via license: Creative Commons Attribution-NonCommercial 3.0 Unported
Content may be subject to copyright.
Pancreatic pseudocysts in Case 3. (A) Axial enhanced chest CT at symptom onset. Mediastinal fluid collections with cystic lesions (arrows) extend along the esophagus (arrowheads in white) and inferior vena cava (arrowhead in black). Bilateral pleural effusions and pericardial effusions are seen. (B) Sagittal enhanced lower chest and upper abdominal CT at symptom onset. The connection between the cysts (arrows) around the liver (asterisk) and the esophagus (arrowheads in white) and the pancreas head with multiple cysts (short arrows) is well identified on the sagittal image. (C) Axial enhanced upper abdominal CT at symptom onset. The pancreas head with multiple cysts (short arrow) and calcification (long arrow) is seen. MPD dilatation (arrowhead in white) is seen in the pancreas body and tail. MPD stricture (arrowhead in black) is suspected in the pancreas head. (D) ERCP obtained 1 week after symptom onset. Dilatation and irregularity of the side branches (short arrows in white) and an MPD stricture (arrowhead in black) are seen in the pancreatic head region.
Source publication
A rare complication of acute or chronic pancreatitis is the formation of a mediastinal pancreatic pseudocyst (MPP), which is caused by tracking of pancreatic fluids through anatomical openings of the diaphragm into the mediastinum. Herein, we report the imaging characteristics of three cases of this condition. Our results revealed three features in...
Contexts in source publication
Context 1
... vena cava hiatus, were noted. Bilateral pleural effusions, pericar- dial effusions, and ascites were also seen. The connec- tion between the mediastinal and abdominal cysts was clearly identified via sagittal images. An enlarged pancreatic head with multiple cysts and calcifications and a dilated MPD of the pancreas body and tail were seen (Fig. 3A-C). Cytological examination of the pleural effusion and ascites was negative for malig- nant cells. The pleural effusion had a high amylase level (540 U/L). On ERCP, dilatation and irregularity of the side branches and an MPD stricture were seen in the pancreatic head region (Fig. 3D). It was not possible to deeply cannulate the MPD in ...
Context 2
... and a dilated MPD of the pancreas body and tail were seen (Fig. 3A-C). Cytological examination of the pleural effusion and ascites was negative for malig- nant cells. The pleural effusion had a high amylase level (540 U/L). On ERCP, dilatation and irregularity of the side branches and an MPD stricture were seen in the pancreatic head region (Fig. 3D). It was not possible to deeply cannulate the MPD in the pancreatic head region because of the focal narrowing of the ...
Similar publications
Introduction. External pancreatic fistulas are developed up to 45 % during the postoperative period after the percutaneous drainage of pancreatic pseudocysts. According to some authors this fact is the main contraindication for using of transcutaneous method in treatment of these patients.The objective is to optimize the tactics of treatment for mi...
Background/aims:
Fever is a common symptom of acute pancreatitis (AP). This study examined the factors associated with fever due to pancreatic inflammation in the early stages of non-biliary AP.
Methods:
This study analyzed the AP database from Kangwon National University Hospital from January 2018 until April 2021 and identified patients who de...
Pancreatic pseudocyst formation is a common complication of chronic pancreatitis. Rarely, a fistula develops between the pseudocyst and the portal venous system. We present a case of a 50-year-old man who was found to have a pancreatic pseudocyst-superior mesenteric vein fistula after being evaluated for several months of abdominal pain and weight...
Pulmonary embolism in the context of pancreatitis is a rare condition and even fewer cases of pulmonary embolism associated with pancreatic pseudocyst and chronic pancreatitis have been reported in the literature. We present the case of a patient diagnosed with chronic pancreatitis due to alcohol ingestion complicated with pancreatic pseudocyst, wi...
La pancreatitis crónica es un trastorno irreversible y progresivo del páncreas caracterizado por inflamación, fibrosis y cicatrización. Las funciones exocrinas y endocrinas se pierden, lo que a menudo conduce al dolor crónico. La etiología es multifactorial, aunque el alcoholismo es el factor de riesgo más importante en los adultos. Si se sospecha...
Citations
... 2,4 Patients with a mediastinal pseudocyst experience breathing difficulties, chest pain, dysphagia, vomiting, weight loss, coughing, hemoptysis, and palpitations. 5,6 Due to the pressure effects caused by its proximity to vital organs, fatal complications such as respiratory failure, airway obstruction, hypotensive shock, pleural effusion, and congestive cardiac failure may occur. 7,8 A delayed diagnosis and a higher risk of complications can result from an inadequate evaluation and workup. ...
... In contrast, mediastinal pseudocysts lack the typical symptoms and usually present with cardiopulmonary and upper Gastrointestinal (GI) symptoms such as dysphagia and dyspnea. 5,6 Our patient complained of chest discomfort, difficulty swallowing, postprandial emesis, and fatigue. The presentation of chronic pancreatitis itself can be vague and overlooked. ...
... CT scan is an ideal modality for delineating a mediastinal pseudocyst and its connection with the pancreas and features of pancreatitis. 5,9 MRI and Magnetic resonance cholangiopancreatography (MRCP) are alternative tools for diagnosis. A pseudocyst usually appears as a uniloculated and encapsulated fluid collection with homogenous density. 1 Pathologies in the pancreatic duct, such as stricture, dilatation, and communication with the pseudocyst, are better visualized with MRCP. ...
Pancreatitis can produce several complications such as pseudocyst, which can happen in acute and chronic pancreatitides. Pseudocysts are typically found in the abdomen but can rarely extend into the mediastinum. Atypical symptoms such as dyspnea, dysphagia, coughing, vomiting, abdominal or chest pain, and hemoptysis are usually the notable complaints. CT scan, MRI, and endoscopic ultrasound are valuable diagnostic modalities. Drainage and surgical removal of the pseudocyst are the treatment options. Herein, we outline the case of a young female with episodic chest and epigastric discomfort, dysphagia, and weight loss. Previously, she was incorrectly diagnosed with gastroesophageal reflux disease and peptic ulcer. A mediastinal pseudocyst secondary to chronic pancreatitis was found to be the cause. The patient underwent surgical removal of the pseudocyst and a pancreaticojejunostomy. Significant improvement was noticed at follow-up. This article highlights the possibility of such unusual conditions and the importance of a proper assessment while treating patients with epigastric pain.
... There are few case reports describing the successful resolution of MPs with EUS-guided transmural drainage of pseudocyst via transesophageal or trans-gastric route [13,[23][24][25][26][27][28][29][30][31][32][33]. These are case reports or small series describing EUSguided trans-esophageal drainage of abdominal fluid collections. ...
Background and aims:
Mediastinal pseudocysts (MP) are rare, and surgery is the conventional treatment modality. However, in the last decade, excellent outcomes have been reported with endoscopic transpapillary drainage. Endoscopic ultrasound (EUS) guided trans-esophageal transmural drainage of MP is a minimally invasive and effective non-surgical treatment modality, but the experience is limited. We aimed to report our experience of EUS-guided transmural drainage in 10 patients with MP's.
Methods:
A retrospective analysis of patients with pancreatic fluid collections treated with EUS-guided transmural drainage over the last ten years was completed to to identify patients with MP's.
Results:
Ten patients (8 males, with a mean age of 34.9±9.17 years) with MP treated with EUS-guided transesophageal transmural drainage were identified. Nine patients with MP had concurrent chronic pancreatitis, and only one had MP following acute necrotizing pancreatitis. The mean size of MP was 5.70±1.64 cm, and nine patients (90%) had concurrent abdominal pseudocyst. EUS-guided transesophageal transmural drainage was technically successful in all ten patients. Transmural plastic stents were placed in 9 patients, whereas one patient underwent single-time complete aspiration of the MP. There were no immediate or delayed procedure-related complications. All ten patients had a successful outcome, with the mean resolution time being 2.80±0.79 weeks. There has been no recurrence of PFC or symptoms in nine (90%) successfully treated patients over a mean follow-up period of 43.3 months.
Conclusions:
EUS-guided trans-esophageal drainage of MP is safe with a high technical and clinical success rate.
... pleural 3,4 . El líquido pancreático asciende a través de aperturas anatómicas del diafragma, habitualmente el hiato esofágico y el aórtico 3 . ...
Resumen
Hombre de 44 años con pancreatitis crónica alcohólica que refiere epigastralgia y disnea. La radiografía de tórax mostró derrame pleural derecho. Se realiza tomografía computarizada abdominal con hallazgo de colección líquida en la cabeza pancreática que se continúa con la crura diafragmática derecha y produce derrame pleural. El análisis del exudado pleural muestra amilasa aumentada.
Las complicaciones torácicas más comunes de las pancreatitis incl uyen derrame pleural y neumonía, mientras que la fístula pancreático-pleural es más rara. La fístula pancreática consiste en la disrupción inflamatoria del conducto pancreático. El líquido pancreático asciende a través de aperturas anatómicas del diafragma, habitualmente el hiato esofágico y el aórtico. El acúmulo torácico de líquido pancreático puede producir derrame pleural o pseudoquiste pleural o mediastínico. El diagnóstico se basa en pruebas de imagen, aunque a veces la fístula es difícil de visualizar. El análisis bioquímico del líquido pleural con aumento de amilasa confirma el diagnóstico.
... It is believed that mediastinal pseudocysts are caused by pancreatic fluid riding up through the diaphragmatic openings, especially the esophageal and aortic openings being the most common entry sites into the posterior mediastinum. 6 This is believed to be due to rupture of the pancreatic duct posteriorly into the retroperitoneal space. Pancreatic pseudocyst symptoms typically include abdominal pain with tenderness, diarrhea, fever, ascites, nausea and vomiting, weight loss, and jaundice. ...
A mass lesion of the gastric cardia or fundus causing an alteration in the normal regular, translucent gastric fundal air shadow on a frontal erect chest radiograph is referred to as “the Kirklin sign.” Here we present “Pseudo-Kirklin sign” observed on the frontal radiograph of a 46-year-old male patient due to a soft tissue shadow/contour deformity of the fundal gas shadow caused by pseudocyst of the pancreas. We evaluated the patient using plain radiography, contrast enhanced computed tomography, magnetic resonance imaging, and endoscopic ultrasound (EUS) with the cyst drained under EUS guidance. So far only two cases of mediastinal pseudocysts have been drained successfully by EUS-guided aspiration
... [3][4][5] The main symptoms are dyspnea, dysphagia, and chest pain. [6] Dysphagia rarely occurs as the presenting symptom and is more common in mediastinal fistulas. [7,8] This is a paper describing an extremely rare case of combined pancreaticopleural and pancreaticomediastinal fistula in a female patient with dysphagia and cervical edema as initial symptoms. ...
Rationale:
Pancreaticopleural and pancreaticomediastinal fistulas are rare complications of pancreatitis. They are often misdiagnosed and there are no strict guidelines of treatment. In this study, we present a brief report of a combined pancreaticopleural and pancreaticomediastinal fistula extending to the cervical region, causing dysphagia and cervical swelling as initial symptoms.
Patient concerns:
A 36-year-old female with history of alcohol abuse and pancreatitis presented progressing dysphagia and mild dyspnea on admission.
Diagnosis:
Chest X-ray and chest and abdominal computed tomography scan (CT) indicated pancreaticopleural fistula combined with pancreaticomediastinal fistula, a diagnosis confirmed by high amylase levels in pleural fluid.
Interventions:
Conservative treatment was administered and ERCP was performed but pancreatic duct stenting was impossible. The patient presented rapid anterior cervical swelling with progressing dysphagia and dyspnea. CT showed fistula penetration to the cervical region. The patient underwent urgent surgery and pancreaticojejunal anastomosis was performed.
Outcomes:
The surgery led to recovery. Six months later, the patient reported good health and weight gain.
Lessons:
Coexistence of pancreaticopleural and pancreaticomediastinal fistula with cervical penetration is an extremely rare pancreatitis complication. It presents with dysphagia and anterior cervical swelling as initial symptoms. It is important to consider this complication in all patients with history of pancreatitis, presenting with dysphagia.
... Медиастинальные панкреатогенные кисты (МПК) относятся к редким осложнениям острого и хронического панкреатита, а также травмам живота. Псевдокисты поджелудочной железы (ПЖ) возникают в исходе панкреонекроза в 7-25% случаев, однако их распространение в средостение встречается только в 0,4% [1,2]. В литературе до 2017 г. описано около 100 таких примеров [3]. ...
Objective:
To present the results of surgical treatment of patients with mediastinalpancreatogeniccysts (MPC).
Material and methods:
There were 5 patients with MPC.
Results:
Laboratory tests revealed increased blood amylase level by 1.5-2 times in 3 cases, urine diastase by 4-5 times - in 2 cases. Pleural effusion with amylase concentration in the fluid from 5680 to 48 640 units was diagnosed in 4 cases. CT data of preudocysts of pancreatic body and tail were obtained in 3 cases, head and body - in 2 patients. These cysts extended to posterior mediastinum through the hiatal orifice for about 3.5-40 cm. Three patients underwent VATS removal of pleural fragments, one - thoracotomy, lung decortication and MPC drainage through pleural cavity. Three patients underwent pancreatic drainage procedures (cystogastrostomy, pancreaticojejunostomy and external drainage of the cyst). A small pseudocyst has been successfully treated by conservative treatment with octreotide.
Conclusion:
MPC is a rare complication of pancreatitis and often associated with pleural effusion. CT and fluid amylase analysis are the main diagnostic measures. Surgical treatment includes VATS, destruction of pleural fragments and pleural drainage, cystogastrostomy, pancreaticojejunostomy or external drainage of pancreatic pseudocyst.
... Air may be seen in the case of infected collections. [73][74][75] MRI with MRCP can demonstrate fistulous communications with the pancreatic duct or the peripancreatic collections. In addition, ductal morphology, such as disruption, communication with pseudocyst, stricture, and dilatation, are best defined by MRCP. ...
Acute pancreatitis in its severe form may lead to systemic inflammatory response syndrome and multisystem organ dysfunction. Acute lung injury is an important cause of mortality in the setting of severe acute pancreatitis. Besides lung involvement, acute and chronic pancreatitis may also lead to the involvement of other thoracic compartments, including mediastinum, pleura, and vascular structures. These manifestations are an important cause of morbidity and may pose diagnostic and therapeutic challenges. These manifestations have not been discussed in detail in the available literature. In this review, we discuss the thoracic complications of pancreatitis, including lung, pleural, mediastinal, and vascular manifestations. Acute lung injury is an important cause of mortality in the setting of severe acute pancreatitis. Besides lung involvement, acute and chronic pancreatitis may also lead to the involvement of other thoracic compartments including mediastinum, pleura, and vascular structures. In this review, we discuss the thoracic complications of pancreatitis including lung, pleural, mediastinal and vascular manifestations.
... Çalışmamızda kronik pankreatit tablosu eşlik etmekte olan 49 ve 50 yaşında iki erkek hastada psödokist mevcuttur. Psödokistler; akut veya kronik pankreatit, travma ve nadiren de büyük duktusların neoplastik tıkanmasıyla ilişkili, non-epitelyal kistik lezyonlardır (21,22). Erkeklerde daha sık görülür ve yaş ortalaması değişkendir (23). ...
Objectives:
In the pancreatic lesion cases, surgery is often planned based only on imaging results and without a preoperative histological diagnosis, due to the high risk of malignancy in combination with the difficulty of invasive interventions and limited cytopathological evaluation. In this study, the records of 20 patients who had undergone a pancreatectomy procedure and who were diagnosed with nonneoplastic pancreatic lesions were retrospectively evaluated according to the clinical and histopathological findings.
Methods:
A total of 122 cases of patients who underwent a pancreatectomy with suspicious lesions between 2004 and 2016 were retrospectively assessed in detail using the clinical and histopathological findings.
Results:
Nonneoplastic lesions were observed in 20 (16%) of 122 patients who underwent a pancreatectomy. Histopathological examination revealed 11 cases of chronic pancreatitis, 1 hematoma, 1 instance of hemorrhagic necrosis secondary to trauma, 1 pseudocyst, 1 granulation tissue, 1 retention cyst, 1 bile duct cyst, 1 patient with Castleman disease, and 1 instance of fat necrosis were seen. In 1 patient, no evidence of disease was found. In addition, among the patients with chronic pancreatitis, autoimmune pancreatitis was observed in 1, adenomyoma of the ampulla of Vater was present in 1, and a pseudocyst was found in 1 patient.
Conclusion:
A clinical and histopathological analysis of nonneoplastic lesions found in pancreatectomy patients was performed.
