A case of complete resolution of mediastinal pseudocyst and pleural effusion by endoscopic stenting of pancreatic duct.
We report a case of a mediastinal pseudocyst with a pleural effusion that developed in a patient suffering from alcohol- related chronic pancreatitis. A 53-year-old man was admitted to another institution complaining of pleuritic chest pain and coughing. A chest X-ray revealed a pleural effusion with a collapse of the right middle and lower lobes. Pleural fluid taken by thoracentesis was exudative, and the patient was transferred to our institution. A CT scan showed a loculated cystic lesion in the mediastinum and pancreatic changes that were consistent with chronic pancreatitis. The endoscopic retrograde cholangiopancreatography (ERCP) findings were compatible with chronic pancreatitis showing severe pancreatic ductal stricture at the head with an upstream dilation and distal bile duct stricture. After a one week of treatment with fasting and octreotide without improvement, both pancreatic and biliary stents were placed endoscopically. After stenting, the pleural effusion and pseudocyst rapidly resolved. The stents were changed 3 months later, at which time a repeated CT demonstrated a complete resolution of the pseudocyst. Since the initial stenting, he has been followed up for 7 months and is doing well with no recurrence of the symptoms, but he will need to undergo regular stent changes. Overall, endoscopic pancreatic stenting appears to be a good option for managing selected cases of mediastinal pancreatic pseudocysts.
Kim
Dong-Ju
DJ
Department of Internal Medicine, Yonsei University College of Medicine, 134 Shinchon-dong, Seodaemun-gu, Seoul 120-752, Korea.
Chung
Hye-Won
HW
Gham
Chang-Woo
CW
Na
Ho-Gyun
HG
Park
Seung-Woo
SW
Lee
Se-Jun
SJ
Chung
Jun-Pyo
JP
Song
Si-Young
SY
Chung
Jae-Bock
JB
Kang
Jin-Kyoung
JK
D004724:Endoscopy; D006801:Humans; D008297:Male; D008479:Mediastinal Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy; D008875:Middle Aged; D010183:Pancreatic Ducts; D010192:Pancreatic Pseudocyst / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy; D010996:Pleural Effusion / Q000150:complications* / Q000628:therapy; D013902:Radiography, Thoracic; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome