Skip to main content
Top
Published in: Journal of Medical Case Reports 1/2015

Open Access 01-12-2015 | Case report

Pancreatic mediastinal pseudocyst presenting as a posterior mediastinal mass with recurrent pleural effusions: a case report and review of the literature

Authors: Vasilis Karamouzos, Dimitrios Karavias, Dimitrios Siagris, Christina Kalogeropoulou, Fay Kosmopoulou, Charalampos Gogos, Dimitrios Velissaris

Published in: Journal of Medical Case Reports | Issue 1/2015

Login to get access

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.
Literature
1.
go back to reference Baydar B, Cantürk F, Alper E, Aslan F, Akpınar Z, Cengız O, et al. Intrahepatic localization of pancreatic pseudocyst: a case report. Turk J Gastroenterol. 2013;24:447–9.CrossRefPubMed Baydar B, Cantürk F, Alper E, Aslan F, Akpınar Z, Cengız O, et al. Intrahepatic localization of pancreatic pseudocyst: a case report. Turk J Gastroenterol. 2013;24:447–9.CrossRefPubMed
2.
go back to reference Shibasaki M, Bandai Y, Ukai T. Pancreatic pseudocyst extending into the liver via the hepatoduodenal ligament: a case report. Hepatogastroenterology. 2002;49:1719–21.PubMed Shibasaki M, Bandai Y, Ukai T. Pancreatic pseudocyst extending into the liver via the hepatoduodenal ligament: a case report. Hepatogastroenterology. 2002;49:1719–21.PubMed
3.
go back to reference Rana SS, Chaudhary V, Sharma V, Sharma R, Dutta U, Bhasin DK. Infected pancreatic pseudocyst of spleen successfully treated by combined endoscopic transpapillary stent placement and transmural aspiration. Gastrointest Endosc. 2014;79:360–1.CrossRefPubMed Rana SS, Chaudhary V, Sharma V, Sharma R, Dutta U, Bhasin DK. Infected pancreatic pseudocyst of spleen successfully treated by combined endoscopic transpapillary stent placement and transmural aspiration. Gastrointest Endosc. 2014;79:360–1.CrossRefPubMed
4.
go back to reference Yu YC, Kao EL, Chou SH, Lin TJ, Lin TJ, Chien CH. Intrathoracic extramedullary hematopoiesis simulating posterior mediastinal mass–report of a case in patient with beta-thalassemia intermedia. Gaoxiong Yi Xue Ke Xue Za Zhi. 1991;7:43–8.PubMed Yu YC, Kao EL, Chou SH, Lin TJ, Lin TJ, Chien CH. Intrathoracic extramedullary hematopoiesis simulating posterior mediastinal mass–report of a case in patient with beta-thalassemia intermedia. Gaoxiong Yi Xue Ke Xue Za Zhi. 1991;7:43–8.PubMed
5.
go back to reference Xu H, Zhang X, Christe A, Ebner L, Zhang S, Luo Z, et al. Anatomic pathways of peripancreatic fluid draining to mediastinum in recurrent acute pancreatitis: visible human project and CT study. PLoS One. 2013;8, e62025.CrossRefPubMedPubMedCentral Xu H, Zhang X, Christe A, Ebner L, Zhang S, Luo Z, et al. Anatomic pathways of peripancreatic fluid draining to mediastinum in recurrent acute pancreatitis: visible human project and CT study. PLoS One. 2013;8, e62025.CrossRefPubMedPubMedCentral
6.
go back to reference Johnston Jr RH, Owensby LC, Vargas GM, Garcia-Rinaldi R. Pancreatic pseudocyst of the mediastinum. Ann Thorac Surg. 1986;41:210–2.CrossRefPubMed Johnston Jr RH, Owensby LC, Vargas GM, Garcia-Rinaldi R. Pancreatic pseudocyst of the mediastinum. Ann Thorac Surg. 1986;41:210–2.CrossRefPubMed
7.
go back to reference Edwards RD, Jardine A, Vallance R. Case report: pancreatic mediastinal pseudocyst–an unusual cause of palpitations. Clin Radiol. 1992;45:128–30.CrossRefPubMed Edwards RD, Jardine A, Vallance R. Case report: pancreatic mediastinal pseudocyst–an unusual cause of palpitations. Clin Radiol. 1992;45:128–30.CrossRefPubMed
8.
go back to reference Olah A, Nagy AS, Racz I, Gamal ME. Cardiac tamponade as a complication of pseudocyst in chronic pancreatitis. Hepatogastroenterology. 2002;49:564–6.PubMed Olah A, Nagy AS, Racz I, Gamal ME. Cardiac tamponade as a complication of pseudocyst in chronic pancreatitis. Hepatogastroenterology. 2002;49:564–6.PubMed
9.
go back to reference Tanaka A, Takeda R, Utsunomiya H, Kataoka M, Mukaihara S, Hayakawa K. Severe complications of mediastinal pancreatic pseudocyst: report of esophagobronchial fistula and hemothorax. J Hepatobiliary Pancreat Surg. 2000;7:86–91.CrossRefPubMed Tanaka A, Takeda R, Utsunomiya H, Kataoka M, Mukaihara S, Hayakawa K. Severe complications of mediastinal pancreatic pseudocyst: report of esophagobronchial fistula and hemothorax. J Hepatobiliary Pancreat Surg. 2000;7:86–91.CrossRefPubMed
10.
go back to reference Bardia A, Stoikes N, Wilkinson NW. Mediastinal pancreatic pseudocyst with acute airway obstruction. J Gastrointest Surg. 2006;10:146–50.CrossRefPubMed Bardia A, Stoikes N, Wilkinson NW. Mediastinal pancreatic pseudocyst with acute airway obstruction. J Gastrointest Surg. 2006;10:146–50.CrossRefPubMed
11.
go back to reference Santoshkumar S, Seith A, Rastogi R, Khilnani GC. Mediastinal pseudocysts in chronic pancreatitis with spontaneous resolution. Trop Gastroenterol. 2007;28:32–4.PubMed Santoshkumar S, Seith A, Rastogi R, Khilnani GC. Mediastinal pseudocysts in chronic pancreatitis with spontaneous resolution. Trop Gastroenterol. 2007;28:32–4.PubMed
12.
go back to reference Leechawengwong M, Berger HW, Romeu J. Spontaneous resolution of mediastinal pancreatic pseudocyst. Chest. 1979;75:632–3.CrossRefPubMed Leechawengwong M, Berger HW, Romeu J. Spontaneous resolution of mediastinal pancreatic pseudocyst. Chest. 1979;75:632–3.CrossRefPubMed
13.
go back to reference Tsujimoto T, Takano M, Tsuruzono T, Hoppo K, Matsumura Y, Yamao J, et al. Mediastinal pancreatic pseudocyst caused by obstruction of the pancreatic duct was eliminated by bromhexine hydrochloride. Intern Med. 2004;43:1034–8.CrossRefPubMed Tsujimoto T, Takano M, Tsuruzono T, Hoppo K, Matsumura Y, Yamao J, et al. Mediastinal pancreatic pseudocyst caused by obstruction of the pancreatic duct was eliminated by bromhexine hydrochloride. Intern Med. 2004;43:1034–8.CrossRefPubMed
14.
go back to reference Suga H, Tsuruta O, Okabe Y, Saitoh F, Noda T, Yoshida H, et al. A case of mediastinal pancreatic pseudocyst successfully treated with somatostatin analogue. Kurume Med J. 2005;52:161–4.CrossRefPubMed Suga H, Tsuruta O, Okabe Y, Saitoh F, Noda T, Yoshida H, et al. A case of mediastinal pancreatic pseudocyst successfully treated with somatostatin analogue. Kurume Med J. 2005;52:161–4.CrossRefPubMed
15.
go back to reference Ishibashi K, Suzuki T, Isoo Y, Tsutsumi H, Tsutsumi H, Nagasawa M, et al. A case of mediastinal pancreatic pseudocysts successfully treated with somatostatin analogue. Nihon Shokakibyo Gakkai Zasshi. 1999;96:176–80.PubMed Ishibashi K, Suzuki T, Isoo Y, Tsutsumi H, Tsutsumi H, Nagasawa M, et al. A case of mediastinal pancreatic pseudocysts successfully treated with somatostatin analogue. Nihon Shokakibyo Gakkai Zasshi. 1999;96:176–80.PubMed
16.
go back to reference Kim D-J, Chung H-W, Gham C-W, Na H-G, Park S-W, Lee S-J, et al. A case of complete resolution of mediastinal pseudocyst and pleural effusion by endoscopic stenting of pancreatic duct. Yonsei Med J. 2003;44:727–31.CrossRefPubMed Kim D-J, Chung H-W, Gham C-W, Na H-G, Park S-W, Lee S-J, et al. A case of complete resolution of mediastinal pseudocyst and pleural effusion by endoscopic stenting of pancreatic duct. Yonsei Med J. 2003;44:727–31.CrossRefPubMed
17.
go back to reference Bhasin DK, Rana SS, Nanda M, Chandail VS, Masoodi I, Kang M, et al. Endoscopic management of pancreatic pseudocysts at atypical locations. Surg Endosc. 2010;24:1085–91.CrossRefPubMed Bhasin DK, Rana SS, Nanda M, Chandail VS, Masoodi I, Kang M, et al. Endoscopic management of pancreatic pseudocysts at atypical locations. Surg Endosc. 2010;24:1085–91.CrossRefPubMed
18.
go back to reference Bhasin DK, Rana SS, Chandail VS, Nanda M, Sinha SK, Nagi B. Successful resolution of a mediastinal pseudocyst and pancreatic pleural effusion by endoscopic nasopancreatic drainage. JOP. 2005;6:359–64.PubMed Bhasin DK, Rana SS, Chandail VS, Nanda M, Sinha SK, Nagi B. Successful resolution of a mediastinal pseudocyst and pancreatic pleural effusion by endoscopic nasopancreatic drainage. JOP. 2005;6:359–64.PubMed
19.
go back to reference Faling LJ, Gerzof SG, Daly BD, Pugatch RD, Snider GL. Treatment of chronic pancreatitic pleural effusion by percutaneous catheter drainage of abdominal pseudocyst. Am J Med. 1984;76:329–33.CrossRefPubMed Faling LJ, Gerzof SG, Daly BD, Pugatch RD, Snider GL. Treatment of chronic pancreatitic pleural effusion by percutaneous catheter drainage of abdominal pseudocyst. Am J Med. 1984;76:329–33.CrossRefPubMed
20.
go back to reference Mallavarapu R, Habib TH, Elton E, Goldberg MJ. Resolution of mediastinal pancreatic pseudocysts with transpapillary stent placement. Gastrointest Endosc. 2001;53:367–70.CrossRefPubMed Mallavarapu R, Habib TH, Elton E, Goldberg MJ. Resolution of mediastinal pancreatic pseudocysts with transpapillary stent placement. Gastrointest Endosc. 2001;53:367–70.CrossRefPubMed
Metadata
Title
Pancreatic mediastinal pseudocyst presenting as a posterior mediastinal mass with recurrent pleural effusions: a case report and review of the literature
Authors
Vasilis Karamouzos
Dimitrios Karavias
Dimitrios Siagris
Christina Kalogeropoulou
Fay Kosmopoulou
Charalampos Gogos
Dimitrios Velissaris
Publication date
01-12-2015
Publisher
BioMed Central
Published in
Journal of Medical Case Reports / Issue 1/2015
Electronic ISSN: 1752-1947
DOI
https://doi.org/10.1186/s13256-015-0582-z

Other articles of this Issue 1/2015

Journal of Medical Case Reports 1/2015 Go to the issue