Mediastinal Pancreatic Pseudocyst With Esophageal Compression Presenting as Acute Chest Pain

Acute pancreatitis is a major cause of inpatient morbidity and mortality. Pancreatitis can be complicated by the formation of pseudocysts, which develop after 4 weeks in the peripancreatic space. Most pseudocysts resolve spontaneously but indications for drainage include superimposed infection or organ compression. We present a rare case of a young male cocaine user who presented with acute chest pain found to have esophageal compression from a large mediastinal pseudocyst. The etiology of the chest pain was misdiagnosed on multiple occasions and attributed to a cardiopulmonary or musculoskeletal source, or esophagitis. He underwent endoscopic ultrasound-guided cystogastrostomy with symptom resolution.