ABSTRACT
Resumen Introducción: Las complicaciones torácicas secundarias a pancreatitis aguda son excepcionales y más aún la presencia de un pseudoquiste mediastinal. Caso Clínico: Hombre de 36 años. Consumidor de marihuana y alcohol. Historia de 6 meses de dolor abdominal y adelgazamiento de 20 kilos. Instalando en la evolución sintomatología respiratoria. Discusión: Se discuten las formas de presentación de esta entidad. Sus etiologías más frecuentes. Se hace énfasis en el rol de la imagenología así como en el análisis del líquido pleural. El enfoque terapéutico es conservador al inicio y en algunos pacientes es quirúrgico en la evolución; con diversas opciones.
Introduction: The thoracic complications secondary to acute pancreatitis are exceptional and even more so the presence of a mediastinal pseudocyst. Case report: 36 year old man. Marijuana and alcohol consumer. History of 6 months of abdominal pain and weight loss of 20 kilos. Installing respiratory symptomatology evolution. Discussion: The forms of presentation of this entity are discussed. Its most frequent etiologies. Emphasis is placed on the role of imaging as well as the analysis of pleural fluid. The therapeutic approach is conservative at the beginning and in some patients it is surgical during evolution; with several options.
Subject(s)
Humans , Male , Adult , Pancreatic Pseudocyst/etiology , Pancreatic Pseudocyst/therapy , Pancreatitis/complications , Pleural Diseases/etiology , Pleural Diseases/therapy , Fistula/etiology , Fistula/therapy , Pancreatic Pseudocyst/diagnosis , Pleural Diseases/diagnosis , Postoperative Period , Tomography, X-Ray ComputedABSTRACT
Pancreatic pseudocyst is a common complication of acute/chronic pancreatitis, but extension of a pancreatic pseudocyst into the mediastinum is a rare occurrence. In this report, we described a case of a 62-year-old male with necrotizing pancreatitis presenting with chest pain and dysphagia caused by a mediastinal pseudocyst. Endoscopic retrograde pancreatography revealed pancreatic duct disruption and leaks. A mediastinal pseudocyst was successfully drained by endoscopic ultrasound (EUS)-guided transesophageal approach. Chest pain and dysphagia disappeared swiftly with drainage. Associated pancreatic pseudocyst at tail was managed by EUS-guided cystogastrostomy and pleural effusion was controlled by percutaneous drainage, respectively. In a follow-up period of 3 months, there has been no recurrence of symptoms and signs. Although currently EUS-guided transesophageal approach was done in the selected cases, this procedure is technically feasible, less invasive and more effective than surgical approach.
Subject(s)
Humans , Male , Middle Aged , Chest Pain , Deglutition Disorders , Drainage , Follow-Up Studies , Mediastinum , Pancreatic Ducts , Pancreatic Pseudocyst , Pancreatitis , Pleural Effusion , Recurrence , UltrasonographyABSTRACT
BACKGROUND: A pancreatic pseudocyst is one of various complications occurring in acute of chronic pancreatitis. It is usually located in the retroperitoneal space near the pancreas. However, other unusual locations are also possible. Jones intially described the mediastinal pseudocyst in 1940. Since then, fewer than 50 cases have been reported. A diagnosis of a mediastinal pseudocyst is accomplished by imaging studies revealing the cystic nature of the mass with evidences of acute or chronic pancreatitis. There is some controversy regarding the appropriate management of mediastinal pseudocyst because of the high mortality and morbidity after surgical management. Here we report a case of a mediastinal pancreatic pseudocyst found in a patient with asymptomatic alcohol-related pancreatitis complicated by the development of a mediastinal peudocyst, which quickly resolved after endoscopic retrograde pancreatic and biliary drainage and subcutaneous injection of a somatostatin analog(octreotide acetate) without any complications.