Traumatic Pseudocyst Research Articles

"The hidden impact": Traumatic pseudocyst of the lung.

"The hidden impact": Traumatic pseudocyst of the lung.

S2924 Ruptured GIST Mimicking Hemosuccus Pancreatitis

INTRODUCTION: Gastrointestinal stromal tumors (GIST) are the most common non-epithelial tumors occurring in the gastrointestinal tract. Even though they are usually solid, they can appear as cystic lesions on imaging leading to a difficult diagnosis. We present a case of a GIST that was initially diagnosed as a pancreatic pseudocyst after extensive work-up. CASE DESCRIPTION/METHODS: A 61-year-old man with no past medical history presented to the ED with abdominal pain after sustaining blunt trauma to the abdomen. Abdominal CT showed a 16 cm left upper quadrant mass with central necrosis and perigastric adenopathy, but no other imaging to compare (Figure 1). During EUS evaluation a thick ring with a central cystic core was noted between the stomach and tail of pancreas. Given this location, traumatic pseudocyst was thought likely. Although the thick wall was somewhat unusual, FNA results were consistent with pseudocyst. PET scan was then performed showing a cystic mass with circumferential heterogenous and mildly increased FDG activity but no adenopathy, supporting a diagnosis of pseudocyst (Figure 2). Unfortunately, the patient was lost to follow up.Eight months later, the patient came to the ED with epigastric abdominal pain associated with black tarry stools. He was tachycardic and the abdomen was distended and tender. Laboratory workup revealed a Hb of 7.1. A CT scan showed the large heterogeneous, cystic mass suggestive of hemorrhagic content as well as ascites (Figure 3). He was admitted to ICU, received 2 units of blood and started on IV pantoprazole. A paracentesis retrieved 1.75 L of hemorrhagic fluid which led to an initial diagnosis of Hemosuccus Pancreatitis. He was not deemed a surgical candidate due to the lesion location and poor nutritional status. A percutaneous catheter was inserted for symptomatic relief and a CT guided biopsy of the wall of the cystic mass was performed. The pathology results were consistent with GIST. DISCUSSION: EUS is a valuable method for evaluation of GISTs by assessing its morphology however, due to the heterogenous appearance, diagnosis can be challenging. Moreover, FNA can yield false negative results due to inadequate amount of tissue, especially if central necrosis is present. This patient's missed diagnosis eventually led to clinical worsening where further work-up was pursued to reveal the definitive diagnosis. GISTs should be considered in your differential despite exhaustive work-up as it may evade diagnosis due to its heterogeneity in morphology and presentation.Figure 1.: Abdominal CT scan on first admission showing a 16 cm enhancing left upper quadrant mass with central necrosis and perigastric adenopathy.Figure 2.: PET scan showing a cystic mass with circumferential heterogenous and mildly increased FDG activity but no adenopathy.Figure 3.: Abdominal CT scan on second admission showing the large heterogeneous, cystic mass suggestive of hemorrhagic content.

TRAUMATIC AND ANEURYSMAL JAW CYSTS: DIFFICULTIES OF THE DIAGNOSIS

The great diversity of the jaw cysts makes the issues of their diagnosis, differential diagnosis, and treatment quite important, always requiring an individual approach, given the features of each clinical case.
 Although the jaw cysts were first mentioned by Scultetus in 1654, the researchers still have different views on the semiotics and classifying individual nosological forms and, consequently, on choosing treatment methods, preventing possible complications and recurrences, and making prognosis.
 Asymptomatic clinical course and absence of characteristic clear clinical manifestations of the jaw cysts and similarity of their signs at separate developmental stages regardless of the nosological form and origin site make this pathology relevant in the practice of maxillofacial surgery. Traumatic and aneurysmal pseudocysts are common in the nomenclature of tumor-like formations of the jaws.
 The paper is concerned with the etiology and pathogenesis, clinical morphological features, and modes of treatment of traumatic and aneurysmal jaw cysts, based on the generalization of the findings of the scientific researches, to emphasize the above nosological forms to the medical community.
 The study encompasses a thorough analysis of the fundamental scientific works and publications in periodicals on the above issues.
 The clinical part of the study concerned a comprehensive examination of 46 children with traumatic and aneurysmal jaw cysts who received treatment at the surgical unit of the Poltava Municipal Children’s Clinical Hospital during the period of 5 years. In addition, 8 adult patients with traumatic cysts were examined and received outpatient treatment at the Department’s clinic.
 Common clinical and additional examination methods, diagnostic puncture, EOD, radiography, CT, and MRI were used to make the clinical diagnosis in serious cases.
 The microscopic structure of the specimens made from the postoperative material using conventional techniques was studied.
 During 2014-2019, 46 children with non-odontogenic jaw cysts (NJC) were treated at the Department of Children’s Oral Surgery, including 24 patients (52.2%) with traumatic cysts (TC) and 15 patients (32.6%) with aneurysmal cysts (AC). That is, TC and AC accounted for 39 cases (84.8%) of NJC. At the same time, while the general age of patients with NJC ranged from 5 to 15 years, TC and AC were most common in children aged 10-15 years, which is consistent with other researchers’ data, who observed the highest incidence in puberty. 25 (64,1%) boys and 14 girls (35.9%) have been involved in the study.
 Generalized statistical analysis revealed that traumatic cysts accounted for 52.2% of children, 32.6% for aneurysmal and 15.2% for other types of non-odontogenic jaw cysts. The patients were predominantly males, and even trauma in the past medical history did not always correspond to and confirm the type of cystic formation.
 The presented material suggests a rather unclear diagnostic “boundary” between traumatic and aneurysmal cysts, when, in fact, the main differential diagnostic criterion is a carefully gathered anamnesis, even at the prehospital stage.
 The given material can be the basis for further in-depth scientific and practical studies on immunohistochemical structural features of traumatic and aneurysmal jaw cysts.

Management of pancreatic trauma in adult patients: a single centre experience

Background: Pancreatic trauma is very rare and its management is complex. The aim of this study was to report our experience in the management of pancreatic trauma.Methods: All patients who were admitted with pancreatic trauma from May 2017 to May 2019 were reviewed retrospectively. Demographic data and baseline characteristics were recorded. Grading of pancreatic trauma was carried out according to the American Association for surgery for Trauma (AAST). Data were represented by frequency and mean.Results: A total of 24 patients were admitted with pancreatic trauma in the study period. Road traffic accident (n=17) was the leading cause followed by falls (n=5) and assault (n=2). Out of 24 patients, 3 patients had grade I pancreatic injury, 6 patients had grade II AAST injury, 9 patients had grade III injury and 6 patients had grade IV injury. No patients had grade V injury. Mean hospital stay was 12.3±4.2 days. One patient with grade 2 injury underwent surgery for liver laceration, all others were managed conservatively. Patients with grade 3 and 4 injuries were managed conservatively. One patient with grade 3 injury required, cystogastrostomy for pseudocyst 1 month after the index admission. Two patients of grade 4 injury underwent surgery, one patient for traumatic pseudocyst after 1 month and another patient for bleeding pseudoaneurysm of gastroduodenal artery 1 month after trauma. No patient underwent pancreatectomy. There was no mortality in the study population.Conclusions: Pancreatic trauma can be managed conservatively irrespective of the grade of injury in haemodynamically stable patients.

Posttraumatic pulmonary pseudocyst: Report of two cases

Posttraumatic pulmonary pseudocyst is a rare complication of blunt thoracic trauma. It is commonly seen in pediatric and young adult patients. In the literature, traumatic pseudocysts are also defined as pseudocystic hematoma, traumatic lung cavity and traumatic pneumatocele. Traumatic pseudocysts usually have good clinical prognosis, recover spontaneously with supportive treatment and do not require surgery. In this report, we present rare cases of two posttraumatic pulmonary pseudocysts developed after traffic accidents, where conservative treatment contributed excellent outcomes.

再度の腹部外傷により再発増悪をきたした外傷性仮性膵嚢胞症の 1 例

再度の腹部外傷により再発増悪をきたした外傷性仮性膵嚢胞症の 1 例

Practice variability exists in the management of high-grade pediatric pancreatic trauma

Management of high-grade pancreatic trauma in children is controversial, although recent evidence supports early operation. We sought to evaluate whether practice variability exists regarding the management of these rare and complex injuries. A study group of pediatric trauma centers within the Pediatric Trauma Society completed a survey following a query of their institutional database. Results are presented using descriptive statistics. Over a 3-year period (2012-2014), 123 pancreatic injuries (grades II-IV) were reported from 19 pediatric trauma centers (median 6, range 1-22). Sixty-two injuries involving injury to the pancreatic duct (clear/suspected) were reported (median 1, range 0-9). Of these, 49% were managed with non-operative management (NOM) and 51% with operative management. Surgeons at the majority (63%) of institutions used both approaches. Of the operative cases, 21% were laparoscopic. There was wide variability in clinical management of NOM patients: the most common feeding strategy was reported by 52% of centers, percutaneous drainage of traumatic pseudocyst by 42% and ERCP (early/after pseudocyst) by 72%. Wide practice variability exists among North American pediatric surgeons regarding both the initial approach to high-grade pancreatic injury and non-operative management. These results highlight the need for a prospective trial to determine the optimal strategy for these patients.

Traumatic pseudocyst due to blunt trauma: Case report

Damage to lung parenchyma due to blunt thoracic trauma often appears as contusion or hematoma. Cavitary lung lesions or pseudocyst formation due to trauma is a rare phenomenon. In the literature traumatic pseudocysts are also known as pseudocystic hematomas, traumatic lung cavity and traumatic pneumotocel. Traumatic pseudocysts usually have good clinical prognosis, recover spontaneously with supportive treatment and do not require surgery. In this article, we present the case of 52 year old male who was brought to the emergency department after a fall from height and was diagnosed with lung contusions and traumatic cyst.

Cystic and Cavitary Lung Lesions in Children: Radiologic Findings with Pathologic Correlation

A number of diseases produce focal or multiple thin-walled or thick-walled air- or fluid-containing cysts or cavitary lung lesions in both infants and children. In infants and children, there is a spectrum of focal or multifocal cystic and cavitary lung lesions including congenital lobar emphysema, congenital cystic adenomatoid malformation, pleuropulmonary blastoma, bronchogenic cyst, pulmonary sequestration, Langerhans cell histiocytosis, airway diseases, infectious diseases (bacterial infection, fungal infection, etc.), hydatid cysts, destroid lung, and traumatic pseudocyst. For the evaluation of cystic or cavitary lung lesion in infants and children, imaging plays an important role in accurate early diagnosis and optimal patient management. Therefore, a practical imaging approach based on the most sensitive and least invasive imaging modality in an efficient and cost-effective manner is paramount. We reviewed the conventional radiographs and computed tomography findings of the most common cystic and cavitary lung lesions in infants and children.

Cisti ossea solitaria: caso clinico

ObjectivesSolitary bone cysts are generally seen in the mandible of young patients. The empty cavity is sometimes lined with a thin layer of connective tissue. During surgical exploration, the cavity fills with blood and the clot that later forms results in full resolution of the cyst. Matherials and methodsWe describe a traumatic pseudocyst that developed in the jaw of a young patient, which was treated with surgical curettage of the cyst cavity and placement of a platelet-rich fibrin (PRF) graft. ResultsOne year after surgery, the follow-up examination revealed complete resolution of the lesion with formation of new trabecular bone. ConclusionsSurgical curettage of the cyst cavity leads to complete healing of mandibular bone cysts. Use of a PRF graft may accelerate this process, especially in soft tissues.

Clinicopathologic Characteristics and Endoscopic Treatment of Post-Traumatic Pancreatic Pseudocysts

Surgery is the treatment of choice for traumatic pseudocyst. Minimally invasive management of these collections has been used. The aim was to analyze the outcome after endoscopic treatment and the integrity of the main pancreatic duct caused by abdominal trauma. A total of 51 patients with traumatic pseudocyst who underwent endoscopic therapy were studied. All were symptomatic with a persistent collection for more than 6 weeks. Endoscopic retrograde pancreatography allowed characterization according to Takishima classification (1, 2, and 3), in which guided therapy was divided into transpapillary drainage (Takishima 2 and 3 without bulging), transmural (type 1), or combined (type 2 or 3 with bulging). Endoscopic retrograde pancreatography was obtained in 47 (90%) of 51 patients. Drainage was transmural in 13, combined in 24, and transpapillary in 10. The success and recurrence rates of endoscopic treatment were 94% and 8%, respectively. There were 9 complications but no procedure-related deaths. Patients with penetrating trauma had more recurrences (P = 0.01) and risk for development of infection (P = 0.045) than those with blunt trauma. Endoscopic treatment of traumatic pancreatic collection is safe and effective and can be considered a first-choice alternative to surgical treatment. Endoscopic retrograde pancreatography and Takishima classification are useful in determining the best endoscopic approach.

Diagnosis and Management of Blunt Pancreatic Trauma in Children

Diagnosis and Management of Blunt Pancreatic Trauma in Children There are still diagnostics problems and variety of opinions about tactics in the treatment of blunt pancreatic injurys. The methods of surgery treatments are more and more replacing the methods of endoscopy and conservative therapy. There is a remarkable diference in the tactic of treatment between adults and children because of the anatomical physiological reasons. Delayed diagnosis of this wounding is connected with heightened morbidity and mortality. Handlebars injury is the most frequent mechanism of the trauma. The most determinant role in the diagnostics has active examination tactic and arsenal of visual diagnostics methods. Therapy approach must be individualized depending from the hemodynamic status, seriosity of injury, existence of associated injuries and the experience in the institution. After traumatic pseudocysts can be successfully drained in US control or endoscopic to stomach. Children with such injuries must be concentrated if possible in the specialized centers.

Endoscopic cystogastrostomy

Endoscopic cystoenterostomy for drainage of pancreatic pseudocyst is a new emerging modality which has rarely been reported in pediatric patients. Only ten successfully performed cases of pediatric endoscopic cystoenterostomy have been reported previously. We report a case of 9 year old male child with post traumatic pseudocyst of pancreas, successfully managed by endoscopic cystogastrostomy. To best of our knowledge, this is the first pediatric case report in Indian literature.

The value of positive arthrography in the diagnosis and pathogenesis of retrofemoral Baker's cysts (author's transl)

Retrofemoral Baker's cysts are occasionally found in athletes; they occur as a result of a rupture in the dorsal part of the bursa semimembranosa gastrocnemia. The rupture itself may occur if there is increased pressure in joints or a considerable increase in the amount of synovial fluid. Ruptures can also occur if the joint wall is inadequately adapted and the synovial fluid fails to flow into the ventral joint spaces, as is possible due to certain movements in some sports. Active movement delays healing of the rupture of the capsule: the para-articular structures become encapsulated or, respectively, adhere to one another. Depending on the duration of the effusion and the amount of fluid, the pseudocyst may become pencil-shaped, spherical, cylindrical or rhomboid. It is, therefore, a traumatic pseudocyst, which occurs as a result of insufficient adaptation, principally in athletes of individuals whose occupation involves typical stresses on the knee joint.

Chylothorax following traumatic pseudocyst of the pancreas

Chylothorax following traumatic pseudocyst of the pancreas

Traumatic pseudocyst of spleen post-laparoscopic cholecystectomy

Traumatic pseudocyst of spleen post-laparoscopic cholecystectomy

Frantz’s Tumour of the Pancreas Presenting as a Post-Traumatic Pancreatic Pseudocyst

A case of a solid, pseudopapillary and cystic tumour of the pancreas in a 13-year-old girl was presented. Shortly after a blunt abdominal trauma, an abdominal mass became manifest. Clinical features and radiological findings suggested a traumatic pseudocyst of the pancreas. Laparotomy and pathology revealed a Frantz’s tumour, which was totally resected. Twelve months after surgery the patient is asymptomatic and CT-scan shows no signs of recurrence or metastasis. To our knowledge, no such acute presentation has ever been described in the literature since the first clinical report of this tumour in 1959.

Pancreatic Mucinous Cystadenocarcinoma in an 11-year-old Girl: A Case Report

Mucinous cystic neoplasms of the pancreas are uncommon and known to occur mainly in middle-aged women. Wepresent a case of pancreatic mucinous cystadeno-carcinoma in an 11-year-old girl who had a past history of bluntabdominal trauma. The tumor was initially mistaken for a traumatic pseudocyst. US and CT revealed a multiloculatedcystic mass in the pancreatic tail. The mass showed good transmission on ultrasonography (US) and had anattenuation value of 10 HU on CT. Metastatic lesions in the liver were also shown on follow-up study.

Formation and resolution of bilateral traumatic pulmonary pseudocysts.

A case of bilateral traumatic pulmonary pseudocysts, an uncommon complication of blunt chest trauma, is presented. The radiologic changes were followed over 6 months until spontaneous resolution had occurred. The mechanism of formation of traumatic pseudocysts and the diagnostic implications are discussed.

Pancreatic disorders in infancy and childhood: Experience with 92 cases

Ninety-two children with pancreatic disorders were treated over a 10-year period. Thirty-three had blunt trauma, while 69 had medical, metabolic, or neoplastic diseases. Children with trauma had either duct disruption (3), gland fracture (4), or pseudocysts formation (26). Operation was required in 30. Pseudocysts were treated with observation alone in three cases, ultrasound-guided percutaneous aspiration in three, surgical external drainage in two, distal pancreatectomy in four, cyst gastrostomy in ten, and cyst-Roux-en-Y jejunostomy in six. Other disorders included pancreatitis (44), neoplasms (10), nesidioblastosis (4), and pancreaticosplenic abscess (2). Treatment for neoplasms included surgical excision in nine and biopsy in one (adenocarcinoma). Patients with nesidioblastosis underwent 95% (near total) pancreatic resection (two after previous unsuccessful 80% resection). Pancreatitis was familial in two cases, necrotizing in two, idiopathic in 11, and secondary to medications in six cases (steroids, 2; L-asparaginase, 4), gallstones in 17, and choledochal cysts in 6. Pancreatitis resolved after observation and conservative therapy in ten idiopathic cases, 4/6 medication-related cases, and following correction of biliary tract disease (15/17) or choledochal cysts (6). Pancreatic resection or drainage was required in the remaining cases. Pancreatic disorders can be accurately detected with computed tomography (CT) scan in most cases (excluding insulinoma). Ultrasound (US) is useful in cases of biliary tract disease and pseudocyst formation. Traumatic pseudocysts can resolve spontaneously or with US-guided percutaneous drainage (in the presence of normal ducts). Children with neoplasms, abnormal pancreatic ducts, or recurrent pancreatitis require resection or appropriate drainage procedures. Overall survival was 95%.