title: Mediastinal Pancreatic Pseudocysts.
abstract: Mediastinal pseudocysts are a rare complication of acute pancreatitis. Lack of uniform treatment standards makes the management of this condition a clinical challenge. We report the case of a 43-year-old patient who presented with a left pleural effusion. Pleural fluid revealed a high amylase concentration consistent with a pancreaticopleural fistula. Endoscopic retrograde cholangiopancreatography (ERCP) revealed a disruption of the pancreatic duct with free outflow of contrast medium into the thoracic cavity. A pancreatic stent was placed. The second day after the ERCP, the patient developed septic shock and was admitted to the intensive care unit. Computed tomography (CT) revealed mediastinal pseudocysts and bilateral pleural effusions. After bilateral drainage of the pleural cavities, the patient improved clinically, and a follow-up CT scan showed that the fluid collection and pseudocysts had resolved. We discuss the optimal strategies for diagnosing and treating patients with pancreatic thoracic pseudocysts and fistulas, as well as review the management of these conditions.
authors.affiliation: Department of Gastroenterology, Pomeranian Medical University, Szczecin, Poland.
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Dąbkowski
authors.affiliation: Department of Gastroenterology, Pomeranian Medical University, Szczecin, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Białek
authors.affiliation: Department of Gastroenterology, Pomeranian Medical University, Szczecin, Poland.
authors.forename: Maciej
authors.initials: M
authors.lastname: Kukla
authors.affiliation: Department of Thoracic Surgery and Transplantation, Pomeranian Medical University, Szczecin, Poland.
authors.forename: Janusz
authors.initials: J
authors.lastname: Wójcik
authors.affiliation: Department of Gastroenterology, Pomeranian Medical University, Szczecin, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Smereczyński
authors.affiliation: Department of Radiology, Pomeranian Medical University, Szczecin, Poland.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Kołaczyk
authors.affiliation: Department of Thoracic Surgery and Transplantation, Pomeranian Medical University, Szczecin, Poland.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Grodzki
authors.affiliation: Department of Gastroenterology, Pomeranian Medical University, Szczecin, Poland.
authors.forename: Teresa
authors.initials: T
authors.lastname: Starzyńska
keywords: Acute pancreatitis; Cholangiopancreatography, endoscopic retrograde; Mediastinal pseudocysts