Pancreaticopleural fistula

Peripherally enhancing tubular pancreatic pseudocyst is seen in the distal body of pancreas, extending superiorly through the esophageal hiatus (to the left of the gastroesophageal junction) with suspicious communication with the left pleural cavity.

There is chronic thrombosis of the entire portal vein and splenic vein with multiple periportal and perisplenic venous collaterals.

Gross left pleural effusion is noted with thin pleural enhancement. Organized hemorrhagic contents are seen in left posterior CP recess. There is passive collapse of left lower lobe and basal segments of left upper lobe.

Mild right pleural effusion is noted.

Gall bladder shows 3 calculi, largest measuring 5.0 mm. The cystic duct is normal.

T2 hyperintense tubular collection is seen in the distal body of pancreas, extending superiorly through the esophageal hiatus (to the left of the gastroesophageal junction) with severely narrow communication with the left pleural cavity. The collection measures 2.1 x 1.1 x 6.7 cms (AP x TR x CC).   The collection is also communicating with pancreatic duct with severe narrowing at the level of communication. Features are consistent with pancreaticopleural fistula.

There is chronic thrombosis of entire portal vein and splenic vein with multiple periportal and perisplenic venous collaterals.

CBD = 8.2 mm, mildly dilated – due to pericholedochal venous collaterals. No evidence of obstructive lesion in the CBD/CHD. Both right and left hepatic ducts are normal.

Gross left pleural effusion is noted with organized hemorrhagic contents in left posterior CP recess.  

Mild splenomegaly is noted.