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Intrathoracic Herniated and Infected Pancreatic Pseudocyst.
Marcel Wehmann1, Martin Freesmeyer, Robert Drescher
1Department of Nuclear Medicine, Clinic of Nuclear Medicine of the Jena University Hospital, Jena, Germany.
Clinical Nuclear Medicine
|April 8, 2026
Summary
A patient with acute pancreatitis and a hiatal hernia developed infected pancreatic pseudocysts. Treatment with antibiotics and drainage led to successful recovery and reduced inflammation.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Radiology
Background:
- A 40-year-old male presented with symptoms of infection, including diarrhea, weight loss, and fever.
- Medical history revealed acute necrotizing pancreatitis and an axial hiatal hernia.
- Elevated C-reactive protein (188 mg/L) indicated significant inflammation.
Purpose of the Study:
- To investigate the cause and management of infected pancreatic pseudocysts extending into the thoracic region.
- To evaluate the effectiveness of combined diagnostic and therapeutic interventions.
Main Methods:
- 18F-FDG-PET/CT scan for imaging infected pancreatic pseudocysts.
- Endosonography and transgastric drainage for pus removal.
- Identification of Klebsiella pneumoniae via microbiological analysis.
- Antibiotic therapy with ampicillin and sulbactam.
- Follow-up ultrasound for monitoring cyst regression.
Main Results:
- 18F-FDG-PET/CT confirmed infected pancreatic pseudocysts extending to the thoracic region via hiatal hernia.
- 200 mL of pus was successfully drained via endosonography and transgastric approach.
- Klebsiella pneumoniae was identified as the causative pathogen.
- Significant regression of pancreatic pseudocysts observed on follow-up ultrasound.
- Patient discharged in satisfactory condition with resolved inflammation.
Conclusions:
- Infected pancreatic pseudocysts can extend into the thoracic cavity, facilitated by conditions like hiatal hernia.
- A multidisciplinary approach involving advanced imaging, minimally invasive drainage, and targeted antibiotics is effective for managing such complex infections.
- Prompt diagnosis and treatment lead to favorable patient outcomes, including reduced inflammation and cyst resolution.
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