Pancreatic pseudocyst with rupture

Case contributed by Zain Khan
Diagnosis almost certain


Sudden onset epigastric pain

Patient Data

Age: 35 years
Gender: Male

For comparison, we will look at imaging performed two weeks prior to the patient's presentation to the emergency department, followed by imaging performed at presentation.

CT conducted two weeks prior


Note the thick walled, rim-enhancing pseudocyst, arising from the tail of the pancreas. The lesion lies within the gastro-splenic space and is indenting on the greater curvature of the stomach. The pancreatic parenchyma enhances homogeneously, without convincing regions of focal necrosis.

CT at presentation


Appreciate the interval partial decompression of the pancreatic tail pseudocyst which has broad contact with the adjacent greater curvature of the stomach. Increased stranding lateral to the stomach can be seen. Interval development of mild to moderate volume free fluid predominately pooling around the liver and in the pelvis is noted. Findings are suspicious for a ruptured pancreatic pseudocyst.

3D reconstruction 2 weeks ago


3D volume reconstruction, created based on CT imaging, demonstrates a spherical pseudocyst arising from the tail of the pancreas. The author of this case would like to thank Nicholas Arnold (Radiographer) for the creation of the 3D volume reconstructions.

3D reconstruction presentation


Note the interval reduction in size and change of morphology of the pancreatic pseudocyst, suggestive of rupture.

Case Discussion

Pancreatic pseudocysts are a known complication of acute pancreatitis. These lesions tend to arise four or more weeks after disease onset. Although these lesions may self-resolve, this case demonstrates one of the potential complications associated with pseudocysts, namely rupture resulting in acute abdominal pain. Other complications to be aware of include infection, mass effect symptoms, bowel obstruction and hydronephrosis.

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.