Mediastinal Pancreatic Pseudocyst-A Case Report and Review of the Literature

Ruchi Gupta, MD; Juan C. Munoz, MD; Praveen Garg, MD; Ghania Masri, MD; Norris S. Nahman, Jr., MD; Louis R. Lambiase, MD

Disclosures

April 11, 2007

Conclusion

Mediastinal pancreatic pseudocyst should be suspected in a patient presenting with atypical chest pain, dyspnea, or dysphagia, in the setting of a clinical history of pancreatitis. The timely and accurate diagnosis is important for this unusual and potentially life-threatening presentation of a common complication of pancreatitis. The finding of a thin-walled low-attenuation cystic mass in the posterior or middle mediastinum in continuity with pancreas and an elevated amylase level on analysis of the cystic content are required for definitive diagnosis. With the limited experience so far transmural drainage using transesophageal or transgastric approach under endoscopic ultrasound guidance appears to be a technically feasible, minimally invasive, and safe procedure for drainage of such mediastinal pancreatic pseudocyst. Physicians should be aware of atypical presentations and treatment options available for such mediastinal extension of a pseudocyst in a patient with a history of acute or chronic pancreatitis.

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