PMC9633578_01
Axial CT scan (A) showing an irregular loculated fluid collection in the tail of the pancreas area measuring 1.6 x 5.5 x 4.5 cm, axial T2 fat sat-weighted MRI image (B) showing persistent complex cystic mass in the pancreatic tail with some heterogeneous signal intensity. Axial 2D FIESTA and T1 fat-suppressed, postcontrast-weighted MRI (C and D) showing mild interval decrease in size of the 2 communicating cystic lesions at the pancreatic tail with interval development of a huge subcapsular fluid collection along the lateral aspect of the spleen. Within these fluid collections there are no enhancing soft tissue components.
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A computerized tomography (CT) scan was ordered and showed an irregular loculated fluid collection in the tail of the pancreas measuring 1.6 x 5.5 x 4.5 cm (Fig. 1A). Six months later, magnetic resonance cholangiopancreatography (MRCP) (Fig. 1B) was performed and showed a persistent complex cystic mass in the pancreatic tail with some heterogeneous signal intensity. The follow-up MRCP (Fig. 1C and D) showed a mild interval decrease in the size of the 2 communicating cystic lesions at the pancreatic tail with interval development of a huge subcapsular fluid collection along the lateral aspect of the spleen, which appeared also to communicate with these 2 previously seen pancreatic tail collections.
Axial CT scan (A and B) demonstrate successful placement of a 14 French transgastric cystogastrostomy tube with distal pigtail loops within the splenic subcapsular space.
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Due to the significant increase in the size of the pancreatic pseudocyst, which now involved the spleen, a percutaneous CT-guided 14 French cystogastrostomy tube with distal pigtail loops was successfully placed within the splenic subcapsular space (Fig. 2A and B).
Placement of modified 14 French Cook multipurpose drain over the wire, under direct fluoroscopic visualization.
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Under direct fluoroscopic visualization, a modified 14 French Cook multipurpose drain in which 3 extra side holes were cut and positioned so that these side holes resided within the gastric lumen, was placed over the wire (Fig. 3).