Solution to Unknown Case # 4 – Pancreatic Psuedocyst

History: Adolescent male with abdominal swelling.

Pancreatic Pseudocyst: Coronal 2D FIESTA (T2 weighted) image of the abdomen reveals a large mass in the left upper quadrant of the abdomen containing T2 hyperintense fluid.

Pancreatic pseudocyst: Axial SSFSE (T2 weighted) of the abdomen reveals the fluid containing mass is abutting the left kidney, indicating it is likely within the anterior pararenal space.

This is a pancreatic pseudocyst. A pancreatic pseudocyst is a fluid collection which is surrounded by a fibrous capsule. Pancreatic pseudocysts usually contain pancreatic enzymes, tissue, debris, and sometimes blood.

The differential diagnosis for this MRI appearance includes a pancreatic pseudocyst, mucinous cystic pancreatic tumor, pancreatic serous cystadenoma, and much less likely pancreatic intraductal papillary mucinous tumor which are usually multilobulated.

Up to 85% of pancreatic pseudocysts occur in the body and tail of the pancreas, and are usually complications of acute or chronic pancreatitis.

Read about this case of gallstone pancreatitis that developed a large intrapancreatic abscess, or walled off necrosis.