PMC8339356_01
A 58-year-old male with dyspnea was referred to our emergency department. Cross-sectional imaging revealed bilateral pleural effusion (A). Although pancreatolithiasis was present in the head of the pancreas (arrowhead) (B) with atrophic pancreas diagnosed as chronic pancreatitis, obvious pancreatic fistula was not observed on contrast-enhanced computed tomography (C).
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Cross-sectional imaging revealed bilateral pleural effusion (Fig. 1A). Although pancreatolithiasis was present in the head of the pancreas (Fig. 1B) with atrophic pancreas diagnosed as chronic pancreatitis, pancreatic fistula was not observed on contrast-enhanced computed tomography (Fig. 1C).
Periesophageal fluid accumulation became apparent with a serum inflammatory response and was diagnosed as acute mediastinitis (A). The inflammation spread to the superior mediastinum (B).
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After treatment, periesophageal fluid accumulation became apparent with a serum inflammatory response, and the patient was diagnosed with acute mediastinitis (Fig. 2A). The inflammation spread to the superior mediastinum (Fig. 2B).
EUS-guided transesophageal drainage of acute mediastinitis. We confirmed the remaining trace of pancreatic fistula from the tail of the pancreas (arrowhead) (A). The accumulated mediastinal fluid was drained from the lower esophagus (B) under EUS guidance. A guidewire was inserted through the puncture needle (C) and an endoscopic nasocystic drainage tube placed (D).
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At the same time, the remaining trace of pancreatic fistula from the tail of the pancreas was confirmed by EUS (Fig. 3A). The accumulated mediastinal fluid was drained from the lower esophagus (Fig. 3B). Then, a 0.025-inch guidewire (VisiGlide2 , Olympus Medical System Corporation) was inserted and a 6-Fr nasocystic drainage catheter placed through the guidewire (ENCD) (Fig. 3C and D).