Chronic pancreatitis and pseudocysts
Recurrent abdominal pain.
Three phase CT
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Three phase CT demonstrates an atrophic distal pancreas, with two discreet cysts. These are thick walled and have central fluid attenuation. The walls somewhat enhance.
The splenic vein is obliterated, replaced by numerous enlarged collaterals at the splenic hilum and along the greater curvature of the stomach. The spleen and liver appear unremarkable.
4 case question available
This patient went on to have a partial pancreatectomy.
Specimen consists of the distal pancreas measuring 11 x 6 x 5 cm. A cross-section of the pancreas shows two separate intact cysts measuring 6 cm and 2.4 cm in greatest dimension that are filled with a pus-like material and necrotic debris.
Pancreatic pseudocyts can be a challenge to manage and up to half of all pseudocysts do not resolve spontaneously. Additionally, when small and in cases where a firm history of pancreatitis is not present, they can pose a diagnostic challenge, and mimic cystic neoplasms.