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RADIOLOGY: PANCREAS: Case# 32835: PANCREATITIS, PSEUDOCYST-PANC. AND TX. MESOCOLON. Patient is a 43 year old female with approximately nine months of abdominal pain. Cystic mass was found in the pancreas on ultrasound. A 3.2 x 3.5 cm pseudocyst is seen in the pancreatic tail. A second pseudocyst is seen approximately 1-2 cm inferior and to the left of this first pseudocyst measuring 3.3 x 3.0 cm. There is a moderate amount of ascites. Inflammatory and congestive changes are seen in the mesentery and the omentum. The splenic vein is patent. Pancreatic pseudocysts are usually the sequelae of pancreatitis, most often associated with the subacute or chronic varieties. Peripancreatic fluid collections in the setting of acute pancreatitis are not pseduocysts. A pseudocyst is a cystic structure with a thick, fibrous wall and is not lined with epithelium (hence, it is not a true cyst). A pseudocyst may have a persistent connection to the pancreatic duct which may be demonstrated by ERCP. Typically, an uncomplicated pseudocyst will have a homogeneous water density. Increased density or inhomogeneity indicate some complicating factor such as hemorrhage or infection. Psuedocysts may also form in the walls of bowel (stomach, duodenum, colon) due to extension of pancreatic enzymes into the surrounding tissues.

Peter Anderson
pancreas, radiology