An unusual neck swelling: Extension of mediastinal pseudocyst into the neck

Clinical manifestations, imaging features, and endoscopic management of renal pseudocysts: a case series

Background

Renal pseudocysts (RP) are rare and we know little about their presentation and management. In the present case series, we present the pertinent clinico-radiological features as well as the role of endoscopic drainage in symptomatic RP.

Methods

A retrospective analysis was performed of patients with RP seen in our unit over the last 12 years. Patient symptoms, imaging findings and details of endoscopic or endoscopic ultrasound (EUS)-guided drainage procedures were evaluated.

Results

Eight patients with RP (7 male; mean age: 33.1 years) were studied. Seven patients had underlying chronic pancreatitis (calcific in 3), predominantly alcohol-related. The mean size of the RP was 8.5 cm. All patients presented with abdominal pain and none had urinary complaints. The RP could be well detected on both contrast-enhanced computed tomography and EUS. None of the patients had significant debris on EUS. Five patients were treated with combined transmural and transpapillary drainage, 2 patients were treated with transpapillary drainage alone, while combined percutaneous and transpapillary drainage was performed in 1 patient. All patients had partial disruption of the main pancreatic duct and a bridging transpapillary endoprosthesis was successfully placed. The RP resolved in all patients within 2-6 weeks and no patient required surgery. There were no complications and no patient had recurrence of RP over a follow-up period of 3-118 months.

Conclusion

RP are usually associated with abdominal pain and do not cause renal symptoms. Endoscopic drainage is a safe and effective minimally invasive management option for RP.

Unusual tubular cystic lesion compressing inferior vena cava

Fluid collections are important local complications of acute pancreatitis (AP). They are usually located in peri-pancreatic region but can also be found in various atypical locations like mediastinum, spleen, liver, pelvis or neck. Such pancreatic fluid collections in atypical locations can cause diagnostic dilemma and may cause delay in management. We report an interesting case of AP who presented to us with a walled-off necrosis mimicking a long cystic mass lesion surrounding the IVC.