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. 2017 Jan;50(1):76-80.
doi: 10.5946/ce.2016.089. Epub 2016 Sep 13.

Mediastinal Pancreatic Pseudocysts

Krzysztof Dąbkowski  1 , Andrzej Białek  1 , Maciej Kukla  1 , Janusz Wójcik  2 , Andrzej Smereczyński  1 , Katarzyna Kołaczyk  3 , Tomasz Grodzki  2 , Teresa Starzyńska  1
Affiliations

Mediastinal Pancreatic Pseudocysts

Krzysztof Dąbkowski et al. Clin Endosc. 2017 Jan.

Abstract

Mediastinal pseudocysts are a rare complication of acute pancreatitis. Lack of uniform treatment standards makes the management of this condition a clinical challenge. We report the case of a 43-year-old patient who presented with a left pleural effusion. Pleural fluid revealed a high amylase concentration consistent with a pancreaticopleural fistula. Endoscopic retrograde cholangiopancreatography (ERCP) revealed a disruption of the pancreatic duct with free outflow of contrast medium into the thoracic cavity. A pancreatic stent was placed. The second day after the ERCP, the patient developed septic shock and was admitted to the intensive care unit. Computed tomography (CT) revealed mediastinal pseudocysts and bilateral pleural effusions. After bilateral drainage of the pleural cavities, the patient improved clinically, and a follow-up CT scan showed that the fluid collection and pseudocysts had resolved. We discuss the optimal strategies for diagnosing and treating patients with pancreatic thoracic pseudocysts and fistulas, as well as review the management of these conditions.

Keywords: Acute pancreatitis; Cholangiopancreatography, endoscopic retrograde; Mediastinal pseudocysts.

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Conflict of interest statement

The authors have no financial conflicts of interest.

Figures

Fig. 1.
Fig. 1.
Chest radiograph demonstrating fluid in the left pleural cavity.
Fig. 2.
Fig. 2.
Endoscopic retrograde cholangiopancreatography showing free outflow of the contrast medium from the proximal portion of the pancreatic tail to the mediastinum (the arrow points to the “leakage”).
Fig. 3.
Fig. 3.
Endoscopic retrograde cholangiopancreatography showing the location of the stent in the pancreatic duct. The stent is placed distally to the fistula, as close as possible to the leakage point.
Fig. 4.
Fig. 4.
(A, B) Abdominal ultrasound depicting pseudocysts in the posterior mediastinum.
Fig. 5.
Fig. 5.
Computed tomography scan of the chest showing mediastinal pseudocysts and pleural fluid.
Fig. 6.
Fig. 6.
Chest radiograph showing fluid resolution after pleural fluid drainage.
Fig. 7.
Fig. 7.
Resolution of pseudocysts on the 12-month follow-up computed tomography scan.
See this image and copyright information in PMC

References

    1. Gupta R, Munoz JC, Garg P, Masri G, Nahman NS, Jr, Lambiase LR. Mediastinal pancreatic pseudocyst: a case report and review of the literature. MedGenMed. 2007;9:8. - PMC - PubMed
    1. Dyrla P, Gil J, Wojtuń S, Florek M, Kasińska E, Zoń R. Pancreatic pseudocyst in the mediastinum. Pol Arch Med Wewn. 2014;124:270–271. - PubMed
    1. Moorthy N, Raveesha A, Prabhakar K. Pancreaticopleural fistula and mediastinal pseudocyst: an unusual presentation of acute pancreatitis. Ann Thorac Med. 2007;2:122–123. - PMC - PubMed
    1. Wronski M, Slodkowski M, Cebulski W, Moronczyk D, Krasnodebski IW. Optimizing management of pancreaticopleural fistulas. World J Gastroenterol. 2011;17:4696–4703. - PMC - PubMed
    1. Dhebri AR, Ferran N. Nonsurgical management of pancreaticopleural fistula. JOP. 2005;6:152–161. - PubMed

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