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Mediastinal pancreatic pseudocysts in children
T M Crombleholme1, A A deLorimier, N S Adzick
1Department of Surgery, University of California, San Francisco 94143.
Insights
Mediastinal pseudocysts, rare pancreatitis complications, require imaging and fluid analysis for diagnosis in children. Consider this diagnosis for unexplained thoracic or abdominal masses.
Area of Science:
- Gastroenterology
- Pediatric Surgery
- Radiology
Background:
- Mediastinal pseudocysts are rare complications of pancreatitis.
- Only four pediatric cases have been previously reported.
- Diagnosis requires advanced imaging and fluid analysis.
Observation:
- Computed tomography (CT) or magnetic resonance imaging (MRI) can define pseudocyst extent.
- Preoperative aspiration of cyst fluid for amylase level confirms diagnosis.
- Endoscopic retrograde cholangiopancreatography (ERCP) aids in planning drainage.
Findings:
- Mediastinal pseudocysts are exceedingly rare in children.
- Diagnosis should be considered for any cystic mass in the abdomen or thorax.
- The diagnosis is possible even without elevated amylase or pancreatitis history.
Implications:
- Early consideration of mediastinal pseudocysts is crucial for pediatric patients.
- Multimodality imaging and diagnostic procedures are essential.
- This condition highlights the importance of a broad differential diagnosis for cystic masses.
Abstract:
Mediastinal pseudocyst is an unusual complication of pancreatitis, with only four cases previously reported in children. The extent of the pseudocyst can be defined by computed tomography or magnetic resonance imaging scan and preoperative aspiration of cyst fluid for amylase level can establish the diagnosis. Endoscopic retrograde cholangiopancreatography to define ductal anatomy can help plan the appropriate drainage procedure. Although exceedingly rare, the diagnosis of pseudocyst should be considered for any cystic mass in the abdomen or thorax, even in the absence of elevated amylase or history suggesting pancreatitis.