Mediastinal Pseudocyst in a Case of Chronic Pancreatitis: A Rare Presentation

Abstract

Pancreatic pseudocysts are collections of fluid localised within the pancreas or in the peripancreatic space, which can occur following acute pancreatitis or in patients with a history of acute pancreatitis and chronic pancreatitis. They are well-known complications of pancreatitis. The pathogenesis of pancreatitis depends on its etiology, where enzyme-rich fluid and products of autoregulation accumulate in acute pancreatitis, and cysts are formed due to obstructed ducts in chronic pancreatitis. The development of pancreatic pseudocysts is more commonly associated with chronic pancreatitis than acute pancreatitis. Unless ruptured, pancreatic pseudocysts are usually not hazardous. Diagnosis of pseudocysts has become easier with advanced diagnostic techniques such as ultrasound and Computed Tomography (CT) scans. Patients presenting with abdominal pain and elevated pancreatic enzymes should be suspected of having pseudocysts. Approximately one-third of these cases resolve spontaneously. In the past, surgery was the only management method, but recently, with newer techniques such as percutaneous drainage and endoscopic cyst enterostomy, management has become easier. Percutaneous drainage, performed under local anaesthesia, is a cost-effective procedure with very low complications. The recurrence rate is higher with single-needle treatment, so catheters are used to decrease recurrence. Drainage should be the first choice of management, but with advancing technology and endoscopic techniques, it may become more useful in the future with skilled practitioners. In this case report, we will examine the case of a 30-year-old male who presented with symptoms of pain in the epigastric region and was diagnosed with a pancreatic pseudocyst. This case demonstrates a rare presentation where the pseudocyst extends into the mediastinum and thorax.