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Karamouzos V, Karavias D, Siagris D, Kalogeropoulou C, Kosmopoulou F, Gogos C, Velissaris D. Pancreatic mediastinal pseudocyst presenting as a posterior mediastinal mass with recurrent pleural effusions: a case report and review of the literature. J Med Case Rep 2015; 9:110. [PMID: 25962880 PMCID: PMC4481071 DOI: 10.1186/s13256-015-0582-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 03/30/2015] [Indexed: 12/30/2022] Open
Abstract
Introduction A rare complication of chronic pancreatitis is the formation of single or multiple mediastinal pseudocysts, which are fueled from the pancreas through anatomical openings of the diaphragm. We present a rare case with a difficult diagnosis, treatment and potentially catastrophic complications. Case presentation A 53-year-old Caucasian man was referred to our hospital for further investigation and treatment of a large heterogeneous mass situated in the posterior mediastinum, and bilateral pleural effusions which had developed after recent multiple episodes of pancreatitis. He had a history of chronic alcoholism. Laboratory and imaging modalities established the diagnosis of a pancreatic mediastinal pseudocyst. Conclusions Despite successful initial conservative treatment, our patient had a relapse and underwent emergency surgical intervention due to internal hemorrhage. We present his diagnostic and imaging workup, along with the multidisciplinary intervention, and a literature review referring to the diagnosis and treatment of mediastinal pancreatic pseudocysts.
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Affiliation(s)
- Vasilis Karamouzos
- Internal Medicine Department, University Hospital of Patras, Rion, 26500, Greece.
| | - Dimitrios Karavias
- General Surgery Department, University Hospital of Patras, Rion, 26500, Greece.
| | - Dimitrios Siagris
- Internal Medicine Department, University Hospital of Patras, Rion, 26500, Greece.
| | | | - Fay Kosmopoulou
- Internal Medicine Department, University Hospital of Patras, Rion, 26500, Greece.
| | - Charalampos Gogos
- Internal Medicine Department, University Hospital of Patras, Rion, 26500, Greece.
| | - Dimitrios Velissaris
- Internal Medicine Department, University Hospital of Patras, Rion, 26500, Greece.
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Brahmbhatt P, McKinney J, Litchfield J, Panchal M, Borthwick T, Young M, Klosterman L. Mediastinal pancreatic pseudocyst with hemorrhage and left gastric artery pseudoaneurysm, managed with left gastric artery embolization and placement of percutaneous trans-hepatic pseudocyst drainage. Gastroenterol Rep (Oxf) 2014; 4:241-5. [PMID: 25502760 PMCID: PMC4976671 DOI: 10.1093/gastro/gou084] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 10/13/2014] [Indexed: 01/09/2023] Open
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.
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Affiliation(s)
- Parag Brahmbhatt
- Division of Gastroenterology and Hepatology, East Tennessee State University, Johnson City, TN, USA,
| | - Jason McKinney
- Division of Gastroenterology and Hepatology, East Tennessee State University, Johnson City, TN, USA
| | - John Litchfield
- Division of Gastroenterology and Hepatology, East Tennessee State University, Johnson City, TN, USA
| | - Mehul Panchal
- Department of Medicine, M. P. Shah Medical College, Jamnagar, Gujarat, India
| | - Thomas Borthwick
- Department of Gastroenterology, James H. Quillen VA Medical Center, Johnson City, TN, USA and
| | - Mark Young
- Division of Gastroenterology and Hepatology, East Tennessee State University, Johnson City, TN, USA
| | - Lance Klosterman
- Department of Radiology, James H. Quillen VA Medical center, Johnson City, TN, USA
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Gupta N, Raghuram K, Puri AS. Recent-onset dysphagia in a young man. Gastroenterology 2013; 144:e1-2. [PMID: 23357059 DOI: 10.1053/j.gastro.2012.09.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2012] [Accepted: 09/25/2012] [Indexed: 12/02/2022]
Affiliation(s)
- Nitin Gupta
- Department of Gastroenterology, G.B. Pant Hospital, Delhi, India
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Panackel C, Korah AT, Krishnadas D, Vinayakumar KR. Pancreatic pseudocyst presenting as dysphagia: a case report. Saudi J Gastroenterol 2008; 14:28-30. [PMID: 19568491 PMCID: PMC2702880 DOI: 10.4103/1319-3767.37801] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2007] [Accepted: 07/11/2007] [Indexed: 11/23/2022] Open
Abstract
Pancreatic pseudocysts are relatively common complications of acute pancreatitis. However, extension of pseudocysts into the mediastinum rarely occurs. In such situations they commonly present with chest pain or shortness of breath. We herein report the case of a patient with a pseudocyst presenting with dysphagia. The clinical presentation, current modalities of diagnosis and management of mediastinal pancreatic pseudocyst is reviewed in this article.
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Affiliation(s)
- Charles Panackel
- Department of Medical Gastroenterology, Medical College, Trivandrum, Kerala, India.
| | - Arun T. Korah
- Department of Medical Gastroenterology, Medical College, Trivandrum, Kerala, India
| | - Devadas Krishnadas
- Department of Medical Gastroenterology, Medical College, Trivandrum, Kerala, India
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Groeneveld JHM, Tjong A Lieng JG, de Meijer PHEM. Resolution of a complex mediastinal pseudocyst in a patient with alcohol-related chronic pancreatitis following abstinence from alcohol. Eur J Gastroenterol Hepatol 2006; 18:111-3. [PMID: 16357630 DOI: 10.1097/00042737-200601000-00020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
We describe a 55-year-old patient with alcoholic chronic pancreatitis, a large mediastinal pseudocyst and a hemorrhagic pleural effusion. A single thoracocentesis and withdrawal of alcohol without other conservative or invasive measures resulted in a complete resolution of the pleural effusion and the mediastinal pseudocyst, which to our knowledge has not been described before.
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Affiliation(s)
- Jan H M Groeneveld
- Department of Internal Medicine, Leiden University Medical Centre, Leiden, The Netherlands.
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Tan MH, Kirk G, Archibold P, Kennedy P, Regan MC. Cardiac compromise due to a pancreatic mediastinal pseudocyst. Eur J Gastroenterol Hepatol 2002; 14:1279-82. [PMID: 12439127 DOI: 10.1097/00042737-200211000-00020] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Cardiac complications from a pancreatic mediastinal pseudocyst are rare. Pericardial effusions associated with pancreatitis have been reported only very occasionally. To the best of our knowledge, the direct extension of a pancreatic pseudocyst into the pericardial sac causing tamponade has not been described before. We present a case in which a pancreatic pseudocyst masquerading as a pericardial effusion dissected into the mediastinum, eroding into the pericardial sac and causing a life-threatening pericardial tamponade. A pericardial catheter was placed producing rapid symptomatic relief. Surgery was avoided by the use of octreotide as an adjuvant to ultrasound guided catheter drainage of the pseudocyst and it resolved completely within 4 weeks of admission to hospital. The importance of rapid and accurate diagnosis of this life-threatening complication is reiterated and the management of pancreatic mediastinal pseudocyst is discussed.
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Affiliation(s)
- Mei Hong Tan
- Departments of Surgery and Radiology, The Royal Victoria Hospital, Belfast, UK
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Edwards RD, Jardine A, Vallance R. Case report: pancreatic mediastinal pseudocyst--an unusual cause of palpitations. Clin Radiol 1992; 45:128-30. [PMID: 1737427 DOI: 10.1016/s0009-9260(05)80069-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
We describe a case of pancreatic mediastinal pseudocyst which presented atypically with palpitations due to marked cardiac compression. Computed tomography (CT) showed a large abdominal pseudocyst extending through the diaphragm into the posterior mediastinum. Surgical drainage produced rapid symptomatic relief and the pseudocyst resolved completely within 2 months.
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Affiliation(s)
- R D Edwards
- Department of Radiology, Western Infirmary, Glasgow
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Crombleholme TM, deLorimier AA, Adzick NS, Longaker MT, Harrison MR, Cox KL, Heyman MB. Mediastinal pancreatic pseudocysts in children. J Pediatr Surg 1990; 25:843-5. [PMID: 1698218 DOI: 10.1016/0022-3468(90)90188-f] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Mediastinal pseudocyst is an unusual complication of pancreatitis, with only four cases previously reported in children. The extent of the pseudocyst can be defined by computed tomography or magnetic resonance imaging scan and preoperative aspiration of cyst fluid for amylase level can establish the diagnosis. Endoscopic retrograde cholangiopancreatography to define ductal anatomy can help plan the appropriate drainage procedure. Although exceedingly rare, the diagnosis of pseudocyst should be considered for any cystic mass in the abdomen or thorax, even in the absence of elevated amylase or history suggesting pancreatitis.
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Affiliation(s)
- T M Crombleholme
- Department of Surgery, University of California, San Francisco 94143
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Sharma S, Puri S, Chaturvedi P, Kulshreshtha R, Baijal VN. Mediastinal pancreatic pseudocyst following traumatic rupture of diaphragm. Pediatr Radiol 1988; 18:337. [PMID: 3387155 DOI: 10.1007/bf02389005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- S Sharma
- Department of Radiology, Safdarjang Hospital, New Delhi, India
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Case Report: Mediastinal Pancreatic Pseudocyst Presenting with Dysphagia and Odynophagia. Am J Med Sci 1987. [DOI: 10.1097/00000441-198706000-00009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Abstract
Among previous cases of mediastinal pseudocyst requiring surgical decompression, all but one had been found at surgery to occupy a position both in the mediastinum and in the upper abdomen. In the present case, although preoperative ultrasound and CT scans suggested that the pseudocyst was straddling the diaphragm, an abdominal portion could not be found at surgery, and the pseudocyst was drained successfully through the diaphragm by a Roux-en-Y loop of jejunum. Because ultrasound and CT scan may not be able to determine the precise relationship of a mediastinal pseudocyst to the diaphragm and the availability of the lower portion of the pseudocyst for surgical decompression, an endoscopic retrograde cholangiopancreatography is strongly recommended as part of the preoperative evaluation.
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Weill F, Brun P, Rohmer P, Belloir A. Migrations of fluid of pancreatic origin: ultrasonic and CT study of 28 cases. ULTRASOUND IN MEDICINE & BIOLOGY 1983; 9:485-496. [PMID: 6676960 DOI: 10.1016/0301-5629(83)90021-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Efficacious management of migratory collections of pancreatic origin requires precise topographic diagnosis. Such collections can be multiple, atypical and ubiquitous, extending from the mediastinum down to the pelvis, within peritoneal recesses and retroperitoneal spaces, and even within viscera such as the liver, spleen or kidney. Sonography and CT are complementary in the diagnosis and management of such collections.
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Ball JB, Clark RA. CT of mediastinal pancreatic fluid collections. COMPUTERIZED RADIOLOGY : OFFICIAL JOURNAL OF THE COMPUTERIZED TOMOGRAPHY SOCIETY 1982; 6:295-300. [PMID: 7172648 DOI: 10.1016/0730-4862(82)90117-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Mediastinal extension of an extrapancreatic fluid collection is a rare event. Only 30 cases have been previously reported in the literature. An additional case is presented. In the appropriate clinical setting, plain film and contrast examination of the esophagus and stomach may suggest the diagnosis. While ultrasound may identify supradiaphragmatic extension of fluid, computed tomography is better able to demonstrate the nature and extent of a mediastinal extrapancreatic fluid collection. Preoperatively it is important to recognize that a mediastinal mass represents an extrapancreatic fluid collection because the preferred surgical approach is abdominal.
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