• Recent history of acute pancreatitis, pancreatic trauma, or known chronic pancreatitis
• Epigastric mass and pain
• Mild fever and leukocytosis
• Persistent serum amylase elevation
• Pancreatic cyst demonstrated by US or CT scan
• Encapsulated collections of pancreatic secretions
• The walls of a pseudocyst are formed by inflammatory fibrosis of the peritoneal, mesenteric, and serosal membranes, which limits spread of the pancreatic juice as the lesion develops
• Pseudocysts develop in about 2% of cases of acute pancreatitis
• Pseudocyst should be suspected when a patient with acute pancreatitis does not recover after 1 week of treatment or when, after improving for a time, symptoms return
• Pseudocysts can contain collections of sterile or infected material
• Abdominal pain is most common
• Weight loss
• Jaundice, due to obstruction of the intrapancreatic segment of the bile duct
• Palpable, tender mass in the epigastrium
• CT scan
-Diagnostic study of choice
-Size and shape of the cyst and its relationship to other viscera can be seen
-A pancreatic duct obstruction may be found with chronic pancreatitis
-A dilated common bile duct suggests biliary obstruction
• US: May be useful to follow changes in size of an acute pseudocyst already imaged by CT scans
• ERCP: Should be performed if there is obstruction or disruption of the pancreatic duct as these findings would require endoscopic or surgical treatment
• With wide use of sensitive imaging studies in the diagnosis of pancreatic disease, small asymptomatic pseudocysts are often demonstrated
• Pancreatic pseudocyst associated with ductal obstruction (chronic pancreatitis) or disruption (trauma) is unlikely to resolve without correction of the underlying defect
• Pancreatic abscess
• Acute pancreatic phlegmon
• Pancreatic adenocarcinoma
• Pancreatic neoplastic cysts
-Account for about 5% of all cases of cystic pancreatic masses
-May be indistinguishable preoperatively from pseudocyst
-Cyst wall must be biopsied to exclude neoplasia
• Serum amylase
• Serum bilirubin
• Abdominal CT
• ERCP if indicated
• Severe symptoms
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