Mediastinal pseudocysts in chronic pancreatitis with spontaneous resolution

A 39 year old male, chronic alcoholic for 12 years, presented with recurrent abdominal pain for last 3 years. He was admitted in our hospital with history of breathlessness, chest pain and abdominal pain for last 20 days. On investigation he had raised total leukocyte count with elevated serum amylase and lipase. Chest radiograph showed mediastinal widening and ultrasound of abdomen revealed chronic pancreatitis with peripancreatic pseudocysts. CT scan revealed extensive phlegmonous collections with cyst formation in the mediastinum which extended from the level of thoracic inlet to below the level of the diaphragm. There were in addition multiple pancreatic and lesser sac pseudocysts. Patient was stable and was hence closely observed on conservative treatment with complete abstinence from alcohol. We performed no surgical, endoscopic or radiological interventions. A repeat CT performed after 14 weeks showed almost complete resolution of the mediastinal pseudocyst. Overall adequate conservative management and timely imaging follow-up before planning any intervention helped us to see that there can be spontaneous resolution of mediastinal pseudocysts.