Mediastinal pancreatic pseudocyst with acute airway obstruction

Pancreatic pseudocysts are usually located in the peripancreatic area, but on rare occasion a pseudocyst can reach the mediastinum. The natural history of mediastinal pseudocysts is poorly understood and seldom reported in the literature. We treated a patient who presented with an acute airway obstruction from a mediastinal pancreatic pseudocyst. Initial acute airway management and stabilization proved successful. A staged cyst decompression via a cervical and abdominal transhiatal approach was ultimately required. The natural history, potential complications, and management of pancreatic mediastinal pseudocysts are reviewed.