PMC10134936_01
(a and b) 2021-5-18 CT of the chest and abdomen (5 months ago): The pseudocyst was progressively enlarged and occupied a large space of the right thoracic cavity, acompanied by left shifting of esophagus and dilatation of pancreatic duct. (c) 2021-6-20 X-ray (4 months ago): The pseudocyst regressed significantly. (d and e) 2021-10-15 CT of the chest and abdomen (before the operation): The pancreatic pseudocyst extended into the posterior mediastinum, accompanied by posterior mediastinal-epigastric cystic mass and compression of the stomach. (f) 2021-10-15 MRCP (before the operation): The pancreatic duct is dilated, but not disrupted. CT: Computed tomography, MRCP: Magnetic resonance cholangiopancreatography
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Five months ago, due to dyspnea, the patient underwent a CT of the chest and abdomen, which showed that the pseudocyst was progressively enlarged and occupied a large space of the right thoracic cavity [Figure 1a], acommpanied with left shifting of esophagus and dilataion of pancreatic duct [Figure 1b]. Four months ago, the X-ray showed the pseudocyst regressed significantly [Figure 1c] and the tube was removed. The CT of the chest and abdomen showed a pancreatic pseudocyst extending into the posterior mediastinum, accompanied by left shifting of esophagus [Figure 1d] and compression of the stomach [Figure 1e]. Magnetic resonance cholangiopancreatography (MRCP) was performed, revealing the pancreatic duct was dilated, but not disrupted [Figure 1f]. The procedure was uneventful [Figure 2 and Video 1].
(a) EUS showed a large cystic lesion was located in the body of the pancreas, which extended into the posterior mediastinum. The maximal cross-section size was approximately 16 cm x 12 cm. (b) Endoscopy showed the lower esophagus and stomach fundus were deformed under compression, and the puncture point was 2 cm below the cardia. (c) EUS image showed the 19G puncture needle was used to puncture the cyst. (d) Endoscopy showed a 0.035-inch guidewire was inserted into the cyst. (e) Endoscopic image showed the tract was dilated using a 10-Fr cystotome followed by a 10-mm balloon dilator. (f) Endoscopy showed two double-pigtail plastic stents and one nasobiliary tube were inserted across the dilation tract
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The maximal cross-section size was approximately 16 cm x 12 cm [Figure 2a]. The puncture point was chosen 2 cm below the cardia [Figure 2b]. The 19G puncture needle (M00550001, Boston Scientific) was used to puncture the cyst [Figure 2c] and 6 mL of cyst fluid was aspirated (cyst amylase: 27071 U/L). Then, a 0.035-inch guidewire (M00556581, Boston Scientific) was inserted [Figure 2d]. The tract was dilated using a 10-Fr cystotome (CST-10, Cook Medical), followed by a 10-mm dilation balloon dilator (MBD-0655-18, Micro-Tech (Nanjing)) for 5 min [Figure 2e]. Two double-pigtail plastic stents (7Fr, 7cm) (ZSO-7-7, Cook Medical) and one nasobiliary tube were placed across the dilation tract [Figure 2f]. The procedure was uneventful [Figure 2 and Video 1].
(a) 2021-10-22 Follow-up CT (2 days after the operation): A dramatic decrease of the cystic size. (b) 2022-5-17 A repeat CT (7 months after the operation): Complete resolution of the posterior mediastinal-epigastric cystic mass. (c) 2022-5-17 Endoscopy (7 months after the operation): Removal of two stents. (d) 2022-7-25 Follow-up CT (2 months after stent removal): Reduction of the mediastinal pseudocyst, with the residual cavity containing viscous proteinaceous effusion. CT: Computed tomography
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Follow-up of CT after 2 days of the operation revealed a dramatic decrease in the cystic size [Figure 3a]. A repeat CT confirmed the complete resolution of the posterior mediastinal-epigastric cystic mass [Figure 3b]. Then, the two stents were removed [Figure 3c]. Follow-up of CT after 2 months reported a reduction of the mediastinal pseudocyst, the residual cavity contains viscous proteinaceous effusion, and the patient is asymptomatic [Figure 3d].