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Case Reports
. 2016 Aug;4(3):241-5.
doi: 10.1093/gastro/gou084. Epub 2014 Dec 9.

Mediastinal pancreatic pseudocyst with hemorrhage and left gastric artery pseudoaneurysm, managed with left gastric artery embolization and placement of percutaneous trans-hepatic pseudocyst drainage

Parag Brahmbhatt  1 , Jason McKinney  2 , John Litchfield  2 , Mehul Panchal  3 , Thomas Borthwick  4 , Mark Young  2 , Lance Klosterman  5
Affiliations
Case Reports

Mediastinal pancreatic pseudocyst with hemorrhage and left gastric artery pseudoaneurysm, managed with left gastric artery embolization and placement of percutaneous trans-hepatic pseudocyst drainage

Parag Brahmbhatt et al. Gastroenterol Rep (Oxf). 2016 Aug.

Abstract

Mediastinal pancreatic pseudocyst (MPP) is a rare, but known, complication of both acute and chronic pancreatitis. Most pseudocysts are associated with alcoholic pancreatitis. Recent advances in endoscopic techniques have shown promising results, with reduced chances of infection and recurrence than with percutaneous drainage, but limited availability restricts widespread use. Left gastric artery pseudoaneurysm with mediastinal pseudocyst has not been described in the literature to date. We report a successful resolution of hemorrhagic MPP with embolization of pseudoaneurysm and percutaneous trans-hepatic pseudocyst drainage.

Keywords: dysphagia; mediastinal pancreatic pseudocyst; percutaneous pseudocyst drainage.

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Figures

Figure 1.
Figure 1.
Circumferential lower periesophageal fluid collection from the superior extension of the pancreatic pseudocyst containing hemorrhage.
Figure 2.
Figure 2.
Intrapancreatic/peripancreatic pseudocysts along the pancreatic tail and body demonstrating a new central density of 33 Hounsfield units compatible with hemorrhage in the pseudocyst.
Figure 3.
Figure 3.
Pseudoaneurysm originating from the branch of left gastric artery
Figure 4.
Figure 4.
Successful embolization of the pseudoaneurysm with Gelfoam pledgets and Tornado coils.
Figure 5.
Figure 5.
Percutaneous trans-hepatic pseudocyst drainage.
Figure 6.
Figure 6.
Management algorithm of MPP.
See this image and copyright information in PMC

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