Cardiac compromise due to a pancreatic mediastinal pseudocyst

Cardiac complications from a pancreatic mediastinal pseudocyst are rare. Pericardial effusions associated with pancreatitis have been reported only very occasionally. To the best of our knowledge, the direct extension of a pancreatic pseudocyst into the pericardial sac causing tamponade has not been described before. We present a case in which a pancreatic pseudocyst masquerading as a pericardial effusion dissected into the mediastinum, eroding into the pericardial sac and causing a life-threatening pericardial tamponade. A pericardial catheter was placed producing rapid symptomatic relief. Surgery was avoided by the use of octreotide as an adjuvant to ultrasound guided catheter drainage of the pseudocyst and it resolved completely within 4 weeks of admission to hospital. The importance of rapid and accurate diagnosis of this life-threatening complication is reiterated and the management of pancreatic mediastinal pseudocyst is discussed.