WWWTP #8 Answer

July 22, 2013

WWWTP


As you recall, this was a 25 year old female presenting with epigastric pain:

Pancreatic pseudocyst 2Pancreatic Pseudocyst 1

This CT shows a large cystic structure measuring 13cm in the epigastric area.  There are also several smaller cystic structures lying adjacent to this within the expected location of the pancreas.  There are inflammatory changes, mainly stranding surrounding these structures.

These are pancreatic pseudocysts.  In acute and chronic pancreatitis these “pseudocysts” can form causing mass effect and abdominal pain.  They can get quite large.  They are called pseudocysts because the walls are made of granulomatous tissue rather than epithelial tissue as in true cysts.  The fluid inside is rich in pancreatic enzymes, blood, and necrotic tissue.  They form when pancreatic cells lyse in acute pancreatitis; the release of pancreatic enzymes cause digestion of surrounding cellular structures and the pseudocyst forms.  Complications of pseudocysts include obstruction (intestinal, gastric, urinary, vascular), hemorrhage, infection, and rupture.  Usually these require surgical formation of a drainage tract between the cyst and an adjacent portion of the GI tract (stomach, duodenum, jejunum).

Ultrasound is another radiologic imaging modality that may used to diagnose and monitor pancreatic pseudocysts.  Unfortunately it is often limited by gastric contents and gas which can get in the way of smaller pseudocyst visualization.  CT is the gold standard.

Author:  Russell Jones, MD

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EMREMS: Radiology in Emergency Medicine

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