Presentation
Epigastric pain with vomiting in a patient on follow-up for pancreatitis.
Patient Data
Large, well-defined pancreatic cystic mass (centered on the head and neck), communicating with a dilated main pancreatic duct. It shows a homogeneous fluid content with a low signal on T1 and a high signal on T2, with a thin rim of peripheral enhancement. It compresses the stomach and duodenum, as well as the distal CBD, with moderate dilatation of the proximal CBD, IHBD, and gallbladder, which contain few stones.
Case Discussion
MRI features of a large pancreatic pseudocyst communicating with the main pancreatic duct and compressing the stomach, duodenum, and distal CBD.
The pancreatic pseudocyst may regress on its own and require no further treatment. Interventions are required in selected cases, such as:
infected cyst
large cyst with mass effect symptoms (gastric outlet obstruction, bowel obstruction, hydronephrosis, biliary obstruction, diameter increasing in size or greater than 5 cm)
recurrence following previous resection or aspiration, and persistent symptoms
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