Research Article

Mediastinal Pseudocyst: Varied Presentations and Management—Experience from a Tertiary Referral Care Centre in India

Table 1

The table shows patient demographics, presentation, clinical and radiological finding, management, and follow-up.

S. numberAge/sexEtiologyAcute/chronicPresenting symptomsSize of mediastinal pseudocystPresence of abdominal pseudocystAssociated  complicationsManagementFollow-up

140/MEthanolChronicGrade 3 dysphagia1 Weight loss Abdominal pain5 cmYes
Communicating with mediastinal pseudocyst
Severe OG2 junction narrowing in barium swallow
Endoscopy could not negotiate beyond oesophagogastric junction
Open cystogastrostomyDysphagia relieved
Postop barium swallow: normal
Gained weight

229/MEthanolAcuteDsypnoea
Pain abdomen
Hemoptysis, 2 weeks following intercostal drainage
8 cmYes
8 × 8 cm infected necrosis involving body & tail of pancreas
Pancreaticopleural fistula
40% necrosis of pancreatic body & tail
Echocardiogram: severe left ventricular dysfunction EF3 37%
Inferior phrenic & intercostal artery pseudoaneurysms
Infected necrosis was managed with 2 percutaneous drainage catheters inserted with ultrasound guidance in left subphrenic & perinephric region
Intercostal drainage
Angioembolisation of pseudoaneurysms
Follow-up
Complete resolution of pseudocyst after 2 months
Echocardiogram: EF 70%

331/MEthanolChronicAbdominal pain
Dsypnoea
4.5 cmYes
Infected pseudocyst 8 × 8 cm: head and body of pancreas
Left pleural effusion
Pancreatic ascites
Three PCDs inserted in left subphrenic, left perinephric region and pelvis
Left intercostal drainage
2 months later, he developed splenic artery pseudoaneurysm: angioembolisation done

436/MEthanolChronicChest pain
Early satiety
Abdominal pain
3 cmYes
8 × 6 cm pseudocyst in head of pancreas
NilOpen cystogastrostomyComplete resolution of pseudocyst after 1 week

539/MEthanolChronicRetrosternal discomfort
Dsypnoea
Pain abdomen
8 cmYes
Multiple peripancreatic pseudocyst
Left pleural effusion/walled-off pancreatic necrosis
Echocardiogram: severe left ventricular dysfunction
EF 40%
Open cystogastrostomy, open necrosectomy,
external drainage
Pseudocyst Resolved
EF improved to 64%

633/MEthanolChronicChest pain
Dysphagia
Abdominal pain
6.5 cmYes.
Multiple peripancreatic pseudocyst
Bilateral pleural effusion
Extrinsic compression over esophagus from 34–38 cm
Open cystogastrostomyResolutions of symptoms

717/FIdiopathicChronicAbdominal pain
Left sided neck pain and edema
4 cmYes
Pseudocyst 2 × 2 cm head of pancreas
Multiple parenchymal and ductal calculi
Left pleural effusion
Left IJV4/brachiocephalic vein thrombosis
Frey’s procedureThrombus recanalised after 6 months of anticoagulant therapy

score of Knyrim et al.
2Oesophagogastric.
3Ejection fraction.
4Internal jugular vein.