Mediastinal pseudocyst with pericardial effusion and dysphagia treated by endoscopic drainage

Pancreatic pseudocysts located in the mediastinum are rare. Symptomatic mediastinal pseudocysts can present with dysphagia, dyspnea, airway obstruction and/or cardiac tamponade. Generally, the standard approaches are surgery and external drainage. Recently, there have been many reports of successful endoscopic drainage mainly using a transpapillary technique. However, there have only been a handful of reports involving successful transmural drainage of mediastinal pseudocysts.

We report a case of a mediastinal pseudocyst developed after a severe blunt trauma. The patient presented with orthopnea and dysphagia. Multidetector computerized scanning of the abdomen and thorax revealed a thin, cystic, low-attenuation mass in the posterior mediastinum associated with compression of the esophagus and significant pericardial effusion. An endoscopic retrograde pancreatogram demonstrated a normal size pancreatic duct with an extravasation of contrast from the tail of the pancreas into the cyst. Ultimately, the cyst was successfully drained trough gastric fundus.

Symptomatic mediastinal pseudocysts communicating with the pericardial sac can be successfully drained using a transmural endoscopic approach without the need for surgery or external drainage.