Pancreas pseudocyst

On the other hand> pancreatic pseudocysts represent the most common cystic masses in the pancreas. Pseudocysts are usually fluid collections with a thick wall that arise secondary to infections or trauma. Differentiation between a true cyst and a pseudocyst hy imaging is very difficult and can only be done by microscopic examination. 

A patient with acute pancreatitis may develop many severe local and systemic complications. Local complications involve fluid collection, necrosis, or abscess in the pancreas. A pancreatic fluid collection (or pancreatic pseudocyst) is a collection of tissue, pancreatic enzymes, and blood that forms weeks after acute pancreatitis. Many pancreatic pseudocysts resolve spontaneously, but some require surgical drainage.5 Rupture of a pancreatic pseudocyst with associated erosion and hemorrhage of major abdominal blood vessels can have a mortality approaching 60% thus, continued monitoring of a pseudocyst is prudent.6... 

Pancreatic abscess is a collection of pus that forms in the pancreas 4 to 6 weeks after acute pancreatitis. Pancreatic abscess is usually less life-threatening than pancreatic necrosis or pancreatic pseudocyst and can be managed with percutaneous drainage.5... 

Fig. 1.80. Pseudocyst. Transverse US scan through the pancreas shows a cystic mass (c) with posterior reinforcement anterior to the pancreatic tail (arrows). Left lobe of the liver (LL)...

CT may demonstrate duct dilatation, focal areas oflow attenuation in the pancreatic parenchyma that correspond to fluid collections (King et al. 1995). Necrosis is recognized as a focal or diffuse area of non-enhancing pancreatic tissue. The pancreas can he enlarged or normal. Other findings include extra-pancreatic fluid collections located in the anterior pararenal space, lesser sac, lesser omentum, and transverse mesocolon. Peripancreatic fat stranding and pancreatic pseudocyst are sometimes encountered (Geier et al. 1990). 

Fig. 3.6. Coronal reformatted image of endoscopically proven pseudocyst based on analysis of cyst fluid at aspiration. Coronal reformatted CT image (left) and coronal single shot fast spin echo MR image (right) shows pseudocyst (arrow) in the tail of the pancreas. Similar information is obtained without the use of radiation at MR imaging...

Fig. 7.20. Image from a 38-year-old man obtained 5 weeks after simultaneous pancreas-kidney transplantation with necrotizing graft pancreatitis and subsequent graft extirpation. Contrast-enhanced helical CT displays remnants of contrast-enhanced pancreatic graft (arrow) surrounded by fluid and thin-walled membrane (arrowhead) representing pseudocyst formation due to necrotizing pancreatitis. Ascites (white asterisk) and renal graft (black asterisk) are also seen...

Fig. 7.21. Image from a 54-year-oldman obtained 5 months after simultaneous pancreas-kidney transplantation with graft pancreatitis and pseudocyst formation. Sonography shows large, partly septated cyst (white asterisk) adjacent to pancreatic graft (not shown) consistent with peripancreatic pseudocyst...

Fig. 7. 25. Image from a 29-year-old man obtained 3 weeks after simultaneous pancreas-kidney transplantation with infected peripancreatic pseudocyst and complex pancreatic-cutaneous fistula. Drainage catheter (arrows) was placed through a cutaneous fistula opening, and sonogram displays large central cavity (arrow) with communication to peritoneal cavity (black arrowhead) and sinus tracts (white arrowhead) in retroperitoneal location...

---