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Pancreatic pseudocyst
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Pancreatic pseudocyst

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Contributors: Lindsay Carafone, Jennifer J. Findeis-Hosey MD
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Synopsis

Pancreatic pseudocyst : Fever, Abdominal mass, Amylase elevated, Epigastric pain, WBC elevated
A pancreatic pseudocyst is a localized, mature, fluid-filled collection without evidence of solid material located outside of the pancreas. It has a nonepithelialized wall of fibrous and granulation tissue, with no necrosis present. Pancreatic pseudocysts typically appear at least 4 weeks after an episode of acute pancreatitis or blunt or penetrating pancreatic trauma. Pancreatic pseudocysts can also form in patients with chronic pancreatitis if there is an acute exacerbation of the underlying pancreatitis. Ten percent of patients with chronic pancreatitis will develop pseudocysts. Pancreatic pseudocysts are more commonly diagnosed in males.

Approximately 40% of cases of pancreatic pseudocyst resolve without intervention, but they may produce a wide range of signs, symptoms, and clinical manifestations. These may include abdominal mass, abdominal pain, fever, chills, and jaundice.

Complications may include duodenal obstruction or biliary obstruction due to pseudocyst expansion, fistula formation into adjacent viscera including the peritoneal, pericardial, and pleural cavities, spontaneous pseudocyst infection, and pseudoaneurysm.

Codes

ICD10CM:
K86.3 – Pseudocyst of pancreas

SNOMEDCT:
111374002 – Pseudocyst of pancreas

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Acute pancreatitis complication
  • Walled-off pancreatic necrosis – Imaging will demonstrate heterogenous fluid collection with both liquid and nonliquid components (as opposed to homogenous density and only liquid components seen on imaging for pancreatic pseudocyst).
  • Pancreatic retention cysts
  • Pancreatic mucinous nonneoplastic cysts
  • Pancreatic lymphoepithelial cysts
  • Benign pancreatic cysts
  • Pancreatic cystic tumors / carcinoma
Note: The pancreatic cystic lesions above can sometimes be differentiated from pancreatic pseudocyst or walled-off pancreatic necrosis if there is a cyst or fluid collection present on imaging before the episode of pancreatitis or pancreatic trauma.

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed:12/12/2017
Last Updated:01/16/2018
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Pancreatic pseudocyst
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A medical illustration showing key findings of Pancreatic pseudocyst : Fever, Abdominal mass, Amylase elevated, Epigastric pain, WBC elevated
Imaging Studies image of Pancreatic pseudocyst - imageId=7911900. Click to open in gallery. caption: 'CT scan of the abdomen demonstrates a well-defined pancreatic fluid collection consistent with a pancreatic pseudocyst.'
CT scan of the abdomen demonstrates a well-defined pancreatic fluid collection consistent with a pancreatic pseudocyst.

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