PMC4052052_01
Axial images of contrast-enhanced CT show peripancreatic fluid collections and their mediastinal extension (white arrow). CT images show a cystic mass in the mediastinum, posterior to heart and right to the thoracic aorta (dotted arrow). At inferior level, fluid collections extend as a long vertical cystic lesion along the greater curvature of the stomach up to the pancreatic tail and to the greater omentum (asterisk) with increased thickening of the perirenal fascial planes (arrowhead) and stranding in the fat surrounding the fluid collections. Small amount of pleural effusion was detected in both thoracic cavities (arrowheads).
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fig1
On CT, the pancreatic fluid collections extended as a long cystic lesion along the greater curvature of the stomach up to the greater omentum (Figure 1).
((a)-(d)) On T2-weighted fat saturated MRI, the fluid collections appear as discrete areas of homogeneous hyperintensity extending from the abdominal cavity to the mediastinum. (e) On T2-weighted fat saturated MRI, the fluid collections are slightly isointense, finding suggestive for proteinaceous or necrotic contents. (f) Coronal T2-weighted MRI image shows the fluid collections extending upward as a long vertical cystic lesion from the retroperitoneum to the mediastinum through the esophageal hiatus.
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T2-weighted images and slightly isointense on T1-weighted images, with mild peripheral enhancement after administration of contrast medium (Figure 2). The isointensity of the fluid collections on T1-weighted images suggested proteinaceous or necrotic contents.
Axial images of contrast-enhanced CT obtained about five weeks after admission show a pseudocyst (3 cm) (arrow) in the pancreatic tail and the complete resolution of both mediastinal fluid collections and pleural effusion.
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fig3
CT scan revealed the development of a fully encapsulated pseudocyst (3 cm), with a thin capsule (2 mm) and a low attenuation fluid content, in the pancreatic tail. CT scan showed also reduction of the intra-abdominal fluid collections and complete resolution of both mediastinal fluid collections and pleural effusion (Figure 3).