CT - Three phase CT
Axial non-contrast
Axial C+ arterial phase
Coronal C+ arterial phase
Axial C+ portal venous phase
Coronal C+ portal venous phase
What is the likely diagnosis?
Pancreatic pseudocysts, with long-standing splenic vein obliteration.
What is the natural history of these lesions?
Most pseudocysts that are less than 4-6 centimeters resolve spontaneously, although this can take some time.
What feature makes them unlikely to spontaneously resolve?
Large cysts and those in persistent communication with the pancreatic duct are less likely to spontaneously resolve.
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.