Fact-sheet: Pancreatic pseudocyst


Updated on 04/19/2018 at 4:14 PM

Note : 0/10
Share

View all RADEOS cases associated with this fact-sheet

Definition

Collection of encapsulated pancreatic fluid within a fibrous capsule

Corresponds to a complication of acute pancreatitis and pancreatic trauma

Preferential location at the body-tail junction of the pancreas (85%), less commonly in the cephalic region (15%). May sometimes develop at a distance from the pancreatic gland and can then be found in a pararenal, juxtasplenic, or even retroperitoneal position.

Time to onset of pseudocysts: approximately 4 weeks after the episode of acute pancreatitis.

Clinical features

Clinical presentation related to its size and complications

Uncomplicated pseudocyst: epigastric pain with mass effect

Complicated pseudocyst, may present as:

  • Biliary tract obstruction: acute abdominal pain and jaundice
  • Rupture into the free peritoneum: generalized abdominal guarding
  • Infection: sepsis, severe sepsis, and sometimes septic shock
  • Vascular: erosion of the splenic or hepatic artery -> hemorrhagic shock, pseudoaneurysm.

Laboratory findings

Uncomplicated pseudocyst: no laboratory abnormalities.

Pseudocyst superinfection: biological inflammatory syndrome with elevated CRP and leukocytosis.

Vascular: hemoglobin drop

Radiography

Plain abdominal film: may show a roughly rounded opacity displacing adjacent digestive structures.

Ultrasound

Cystic lesion with anechoic content, but sometimes containing internal echoes related to cellular debris.

Infectious complications of the pseudocyst may result in a highly heterogeneous appearance of the content related to pus formation.

CT

Round, homogeneous lesion, hypodense with fluid density before contrast administration.

Marked enhancement of the thin peripheral fibrous capsule surrounding it after contrast administration.

Signs of complications:

  • Lesion retraction and effusion in case of rupture
  • Pseudoaneurysm associated with hemoperitoneum in case of vascular erosion
  • Heterogeneous appearance of its content in case of abscess formation.

MRI

T2 hyperintense/T1 hypointense

Enhancement of the fibrous capsule on post-contrast sequences.

No communication with the pancreatic duct.

Differential diagnosis

Congenital cysts

Polycystic disease or Von Hippel-Lindau disease

IPMN

Mucinous and serous cystadenoma

Acute peripancreatic fluid collection