Mediastinal pancreatic pseudocysts

Abstract

Three patients with mediastinal extension of pancreatic pseudocysts are presented. Clinical manifestations included a history of esophageal obstruction and pleural effusion in two patients, and in none of the three could an epigastric mass be palpated. The pseudocysts traversed the diaphragm by way of the esophageal hiatus in two patients and by erosion directly through the diaphragm in the third case. The latter occurrence has never been described before. The diagnosis of mediastinal pseudocyst should be considered in patients with lower mediastinal masses seen on chest roentgenogram, in whom barium studies show displacement of the distal esophagus and stomach by a retrogastric mass. Although the predominant clinical manifestations are related to the chest, proper management should include cystography, laparotomy, and cystenteric anastomoses. Two of our patients underwent thoracotomy and both eventually required laparotomy to cure the pseudocyst. External drainage in two patients was followed by recurrence of the pseudocyst, emphasizing the importance of internal drainage. Although mediastinal extension of a pancreatic pseudocyst, as described in this report, is uncommon, pleural effusion and atelectasis are frequent thoracic complications of pancreatic pseudocysts limited to the abdomen.