Pancreatic pseudocyst extending into the mediastinum: A rare site for extension

A 29-year-old male, alcoholic for 10 years, presented with abdominal pain, chest pain and discomfort for 2 weeks. Ultrasound of the abdomen revealed a bulky heterogeneous pancreas with multiple ill-defined cy stic collections in the peripancreatic region. Contrast enhanced computed tomography (CT) showed a bulky and heterogeneous pancreas with peripancreatic fat stranding. Multiple intra-pancreatic and peripancreatic cystic collections were noted within the head, body and tail of the pancreas (Fig. 1). A thin-walled cystic lesion was seen arising from the body of the pancreas and extending upwards, tracking through the oesophageal hiatus into the mediastinum. Gross free fluid was noted in bilateral (right > left) pleural cavities with underlying subsegmental atelectasis, suggesting gross bilateral pleural effusion. There was no evidence of ascites (Figs. 2 and 3).

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FIG 1.

Post contrast CT axial window showing multiple pseudocysts seen arising from the substance of pancreas (white arrows).

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FIG 2.

Post contrast CT showing pseudocyst in the mediastinum through the diaphragm (arrows) in (a) axial, (b) coronal and (c) sagittal windows.

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FIG 3.

(a-d) Post contrast CT in axial window showing the pseudocyst arising from the pancreas and extending into the mediastinum (arrows).

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Pseudocyst is a common complication of pancreatitis. Although rare, it may be seen extending into the mediastinum.¹ These patients present with atypical symptoms such as epigastric pain, dyspnoea, dysphagia and retrosternal pain. Radiological investigations are confirmatory for the diagnosis of pseudocysts.²