Unusual manifestations of pancreatic pseudocysts and their surgical management

Christensen, Norman M.; Demling, Robert H.; Mathewson, Carleton

doi:10.1016/0002-9610(75)90371-2

Cited by 40 publications

(12 citation statements)

References 33 publications

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“…4 6 8 The most common symptoms are represented by chest pain, dyspnea, and weight loss. 3 Abdominal complains can often be very mild. 3 Some patients suffer from dysphagia.…”

Section: Discussionmentioning

confidence: 99%

“…3 Abdominal complains can often be very mild. 3 Some patients suffer from dysphagia. 3 The chest radiograph can sometimes show a mediastinal mass and often also a pleural effusion with high amylase activity.…”

Section: Discussionmentioning

confidence: 99%

“…3 Some patients suffer from dysphagia. 3 The chest radiograph can sometimes show a mediastinal mass and often also a pleural effusion with high amylase activity. Contrast oesophagogram can show oesophageal displacement, which was not found in our case.…”

Section: Discussionmentioning

confidence: 99%

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A rare cause of mediastinal expansion with a massive pleural effusion

Subrt

Ferko

et al. 2005

Postgraduate Medical Journal

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The authors present a case of a 53 year old woman, who was admitted to hospital because of an unusual cause of massive pleural effusion. During diagnostic examination the mediastinal propagation of the pancreatic pseudocyst was discovered as a complication of the chronic calcifying pancreatitis. The patient was operated on and the pseudocyst was resolved by Roux-en-Y cystjejunostomy. The diagnostics and treatment of this unusual pancreatic pseudocyst spreading is discussed. P ancreatic pseudocysts are localised collections of the pancreatic juice surrounded by granulation tissue. They arise within the pancreas or in the peripancreatic space after an inflammatory process attributable to an acute and chronic pancreatitis or trauma. Pseudocysts develop in 5%-10% of patients with and acute episode of pancreatitis and in 20%-40% patients with chronic pancreatitis.1 Sometimes they can have a very uncommon localisation. CASE REPORTA 53 year old woman presented with a four week history of dyspnea, cough, and chest pain located behind the sternum and radiating to the left clavicle and back. The patient also complained of mild epigastric discomfort after oral intake and of nine kilograms weight loss within the past month. Eleven years before the admission the patient had been treated for three episodes of severe acute pancreatitis of biliary aetiology. There was also heart ischaemic disease with myocardial infarction 11 years previously and arterial hypertension in the patient's history.Examination showed dull percussion and weakened breath sounds on the chest right side. There was only mild increase of serum and urine amylase values in the laboratory findings (4.08 mkat/l, 8.25 mkat/l respectively; normal serum value in our laboratory: 0.47-1.67 mkat/l, urine concentration: 0-7.67 mkat/l), other laboratory tests were normal. ECG confirmed the history of the myocardial infarction but did not show any acute pathology.Chest radiography showed a massive right sided pleural effusion. Repeated thoracocenteses yielded amount of 3900 ml of sanguineous fluid with a high amylase activity, 93.3 mkat/l. Consecutive chest sonography confirmed residual pleural effusion and showed cystic expansion measuring 65-70 mm in diameter in the posterior mediastinum behind the left cardiac atrium. Bronchoscopy did not show any abnormality and TB was excluded.Computed tomography of the chest and abdomen was performed and helped establishing the final diagnosis. CT scan showed the right sided pleural effusion but not pulmonary parenchyma infiltration or mediastinal lymphadenopathy. Cystic expansion 906706140 mm in the lower part of the posterior mediastinum between aorta and cardiac atrium communicating with pancreas was also found. Pancreatic changes were consistent with chronic calcifying pancreatitis without dilatation of the main pancreatic duct (figs 1, 2). The definitive diagnosis was mediastinal extension of a pancreatic pseudocyst. An endoscopic retrograde cholangiopancreatography (ERCP) was not performed because the computed tomogram show...

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“…4 6 8 The most common symptoms are represented by chest pain, dyspnea, and weight loss. 3 Abdominal complains can often be very mild. 3 Some patients suffer from dysphagia.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

A rare cause of mediastinal expansion with a massive pleural effusion

Subrt

Ferko

et al. 2005

Postgraduate Medical Journal

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“…Three cases of mediastinal extension of pancreatic pseudocyst are presented, and the 20 cases previously reported in the English literature are reviewed [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

“…Occasionally, the serosa of an adjacent viscus may form part of the cyst wall. The usual location is within the lesser sac; however, as the pseudocyst enlarges, it dissects along tissue planes of least resistance and may present as a mass in other locations.Three cases of mediastinal extension of pancreatic pseudocyst are presented, and the 20 cases previously reported in the English literature are reviewed [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17].A 47-year-old white housewife was admitted with a 2-week history of left upper quadrant pain, occasional nausea and vomiting. She had been previously hospitalized for a similar episode with a presumptive diagnosis of peptic ulcer disease.…”

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confidence: 99%

Mediastinal pancreatic pseudocyst

Weinfeld

Kaplan

1979

Gastrointest Radiol

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The extension of a pancreatic pseudocyst into the mediastinum is a difficult clinical and radiographic diagnosis. The chest roentgenogram reveals a retrocardiac mass in a patient with nonspecific upper abdominal and chest complaints. Usually there is a preceding history of alcoholism or pancreatitis. The upper gastrointestinal series often demonstrates typical displacement of the distal esophagus anteriorly and to the left. The value of computed tomography is illustrated. Correct preoperative diagnosis is important for proper surgical treatment, since a mediastinal pseudocyst is best managed without thoracotomy.

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