Presentation
Sudden onset epigastric pain
Patient Data
For comparison, we will look at imaging performed two weeks prior to the patient's presentation to the emergency department, followed by imaging performed at presentation.
Note the thick walled, rim-enhancing pseudocyst, arising from the tail of the pancreas. The lesion lies within the gastro-splenic space and is indenting on the greater curvature of the stomach. The pancreatic parenchyma enhances homogeneously, without convincing regions of focal necrosis.
Appreciate the interval partial decompression of the pancreatic tail pseudocyst which has broad contact with the adjacent greater curvature of the stomach. Increased stranding lateral to the stomach can be seen. Interval development of mild to moderate volume free fluid predominately pooling around the liver and in the pelvis is noted. Findings are suspicious for a ruptured pancreatic pseudocyst.
3D volume reconstruction, created based on CT imaging, demonstrates a spherical pseudocyst arising from the tail of the pancreas. The author of this case would like to thank Nicholas Arnold (Radiographer) for the creation of the 3D volume reconstructions.
Note the interval reduction in size and change of morphology of the pancreatic pseudocyst, suggestive of rupture.
Case Discussion
Pancreatic pseudocysts are a known complication of acute pancreatitis. These lesions tend to arise four or more weeks after disease onset. Although these lesions may self-resolve, this case demonstrates one of the potential complications associated with pseudocysts, namely rupture resulting in acute abdominal pain. Other complications to be aware of include infection, mass effect symptoms, bowel obstruction and hydronephrosis.
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