Mediastinal extension of a pancreatic pseudocyst

Abstract

A 50-year-old man with a history of chronic pancreatitis due to alcoholism presented with dyspnea, at which time he was diagnosed with pleural effusions, treated, and discharged. Two months later, he was readmitted with hemoptysis and abdominal pain. CT and MRI of the chest demonstrated a mediastinal cystic mass that communicated with the retroperitoneum. Ultrasound-guided aspiration of the cystic mass revealed high levels of amylase, confirming that the mass was a rare pancreatic pseudocyst extending into the mediastinum.

Keywords: Mediastinal extension; Pancreatic Pseudocyst; Pancreatitis; Pseudocyst.

Fig. 1

Imaging at initial admission. (A & B) Axial and sagittal views, respectively, of a CT with IV contrast demonstrating bilateral pleural effusions. Incidentally, a chest tube drains the right pleural effusion.

Fig. 2

Imaging 2 months later at second admission. (A, B, & C) Coronal, axial, and sagittal views, respectively, of a CT with IV contrast demonstrating a new, large, nonenhancing, subcarinal fluid collection (horizontal arrows). Coronal (D) and axial (E) fat-saturated T2W MRI and a sagittal (F) fat-saturated T1W MRI with IV contrast also demonstrate a large, nonenhancing, subcarinal fluid collection (arrows) and bilateral pleural effusions (vertical arrows). (The color version of this figure is available in the online edition.)

Fig. 3

Images 2 months after second admission and treatment. (A, B, & C) Coronal, axial, and sagittal views, respectively, from a CT with IV contrast demonstrate near complete post-treatment resolution of the pancreatic pseudocyst. Incidentally, a drainage catheter resides at the location of the obliterated pseudocyst (arrow). (The color version of this figure is available in the online edition.)