SESSION TITLE: Disorders of the Pleura SESSION TYPE: Affiliate Case Report Slide PRESENTED ON: Monday, October 30, 2017 at 11:00 AM - 12:00 PM INTRODUCTION: Development of pseudocysts is common in patients with chronic pancreatitis. Usually pseudocysts are located within the abdomen or the pancreatic body. Mediastinal pancreatic pseudocysts represent a rare complication associated with chronic pancreatitis.1 Depending on location patients may present with dyspnea or dysphagia2. CASE PRESENTATION: A 42 year old female presented with one month history of progressively worsening dyspnea and pleuritic chest pain. She endorsed mild abdominal pain without nausea, vomiting or diarrhea. Past medical history was relevant for recent pleural effusion two months prior, chronic pancreatitis and alcohol dependence. She was slightly tachypneic and hypoxic. On exam she had dullness to percussion of the left chest wall. Abdominal exam showed present bowel sounds with mild epigastric tenderness, without abdominal distension. Chest xray suggested whiteout of the left lung field with contralateral shifting of the mediastinum. CT scan of the chest showed a large left sided pleural effusion with contralateral mediastinal shift and passive collapse of the lung, abnormal paraesophageal fluid collection continuing through the esophageal hiatus into the gastrohepatic ligament was seen. Thoracentesis was performed which showed an exudative effusion, with an amylase level of 10377. Microbiologic and Histopathologic analysis failed to show evidence of infection or malignancy. MRCP did not show any pancreatic ductal obstruction or pancreatic fistula to the mediastinal collection. It was determined that the cause of her pleural effusion was rupture of the mediastinal collection representing a pancreatic pseudocyst. She underwent surgical lysis of adhesions and decortication of pleura. At 3 month follow up post discharge patient failed to show evidence of reaccumulation of mediastinal or ascitic fluid. DISCUSSION: Conservative management with somatostatin analogues is the mainstay therapy for pancreaticopleural fistula prior to surgical intervention. In our patient we opted for surgical resection as there was no active communication between the pancreas and the pseudocyst. CONCLUSIONS: We present a rare case of a mediastinal pancreatic pseudocyst that manifested as a recurrent large pleural effusion requiring surgical intervention. Reference #1: Drescher R, et. al. Mediastinal pancreatic pseudocyst with isolated thoracic symptoms: a case report. Journal of Medical Case Reports. 2008;2:180. Reference #2: Chettupuzha AP, et. al. Pancreatic pseudocyst presenting as odynophagia. Indian J Gastroenterol. 2004;23:27-28. DISCLOSURE: The following authors have nothing to disclose: Syed Iqbal, Catherine Stadler, Javed Iqbal No Product/Research Disclosure Information