PMC8651394_01
CT pulmonary angiogram. (a) Axial image at the level of the left atrium reveals a large fluid collection in the posterior mediastinum, anterior to the esophagus and aorta, with a thickened and enhancing wall. (b) Axial image at the level of the pancreatic body reveals a similar fluid collection at the level of the pancreatic body. Also noted is heavy calcification of the pancreatic parenchyma, in keeping with chronic pancreatitis. (c) Sagittal CT demonstrates the continuous fluid collection extending from the posterior mediastinum at the level of the carina, to the level of the pancreas.
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Evaluation of the surrounding structures revealed a mass effect on the esophagus (Figure 1).
MRI/MRCP examination of the abdomen with and without contrast. (a, b) MRCP sequences demonstrate a hyperintense tubular fluid collection extending towards the mediastinum and a tortuous dilated pancreatic duct with multiple ectatic side branches. (c) Axial T2 HASTE sequence demonstrates a hyperintense fluid collection in the posterior mediastinum, anterior to the esophagus and aorta. (d, e) Axial and coronal postcontrast T1 sequences reveal a hypointense fluid collection and enhancement of the surrounding wall of the collection. In addition, the coronal image demonstrates communication of the collection between the peripancreatic region and the mediastinum.
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A follow-up MRI/MRCP abdomen confirmed acute on chronic pancreatitis with a peripancreatic T2 hyperintense fluid collection extending into the mediastinum (Figure 2).
Two-month follow-up contrast-enhanced CT. (a) Axial image at the level of the left atrium reveals significant interval decrease in the posterior mediastinal fluid collection, with a thickened and enhancing wall. However, the patient has developed a left loculated pericardial effusion (yellow arrow). (b) Axial image at the level of the lung bases demonstrates a small partially loculated left pleural effusion. (c) Sagittal CT demonstrates a significant decrease in the continuous fluid collection extending from the posterior mediastinum at the level of the carina, to the level of the pancreas.
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However, there was also interval development of a small partially loculated left pleural effusion and a left loculated pericardial effusion (Figure 3).