Pancreatic pseudocyst in the mediastinum.

270 We present a case of a 61 ‐year ‐old man with a his‐ tory of pancreatitis, who presented at the emer‐ gency department with chest pain, vomiting, and dysphagia. His blood count, the levels of cardi‐ ac and liver enzymes and electrolytes, as well as the results of renal function tests were normal. An electrocardiogram revealed sinus rhythm with‐ out any changes of ischemia. Chest X ‐ray with contrast showed restriction in the distal esoph‐ agus without infiltration of the wall (FIGURE 1A). Endoscopy showed compression of the distal esophagus by an extrinsic mass (FIGURE 1B). Com‐ puted tomography (CT) scans of the back medi‐ astinum revealed a pseudocyst extending from the abdomen to the chest through the hiatus of the esophagus (FIGURE 1C). Endoscopic retro‐ grade cholangiopancreatography (ERCP) showed normal ductal anatomy. There was no communi‐ cation between the pancreatic duct and the pseu‐ docyst (FIGURE 1D). Endosonography (EUS)‐guided drainage of the mediastinal pancreatic pseudo‐ cyst was performed through the terminal esoph‐ agus using linear EUS. Two passes were made with a 19 ‐gauge needle using a transesophageal approach, and 200 ml of serous amber fluid was removed (FIGURE 1E). High levels of amylase were observed in the fluid (15,774 U/l). Tumor mark‐ ers were within normal ranges. A control CT scan did not confirm the cyst near gastroesophageal hernia, and there was no pathology in the back mediastinum (FIGURE 1F). Pancreatic pseudocysts are diagnosed accidentally in 20% of the patients and on autopsy in 24% of the patients.1 A pseu‐ docyst occurs in 7% to 15% of the patients with Correspondence to: Przemysław Dyrla, MD, PhD, Wojskowy Instytut Medyczny, Klinika Gastroenterologii, ul. Szaserów 128, 04-141 Warszawa 44, Poland, phone: +48 -22-681 -80 -61, fax: +48 -22-681 -75 -99, e -mail: [email protected] Received: March 13, 2014. Revision accepted: March 19, 2014. Published online: March 21, 2014. Conflict of interest: none declared. Pol Arch Med Wewn. 2014; 124 (5): 270-271 Copyright by Medycyna Praktyczna, Kraków 2014 FIGURE 1 A – X ‐ray imaging of the esophagus with contrast water; B – compression of the distal esophagus by an extrinsic mass in endoscopy; C – computed tomography scan showing a cystic mass extending from the border of the pancreatic body and tail into the mediastinum; D – no communication between the pancreatic duct and the pseudocyst on endoscopic retrograde cholangiopancreatography; E – endosonography ‐guided drainage of the mediastinal pancreatic pseudocyst through the terminal esophagus; F – computed tomography scan without a cystic mass in the mediastinum CLINICAL IMAGE