Represents the majority of cystic pancreatic lesions.
Peripancreatic fluid collection with high concentrations of pancreatic enzymes within a wall of granulation tissue without an epithelial lining
Often the result of acute pancreatitis.
10% of patients with acute pancreatitis develop pancreatic pseudocysts.
Other etiologies for pancreatic pseudocysts are chronic pancreatitis, penetrating trauma, and blunt trauma.
Are mature fluid collections outside the pancreas, which develops 4 weeks after the onset of non necrotizing acute pancreatitis.
A pancreatic pseudocyst has an enhancing capsule that does not contain an epithelial lining, and the fluid inside the cyst is opaque, dark, and of low viscosity without solid material.
They are usually unilocular solitary cysts ranging from 2 – 20 cm in size.
The fluid collections are usually sterile but may become infected or hemorrhagic.
Abdominal pain, early satiety, and weight loss are the most common symptoms.
The diagnosis is suspected when abdominal pain continues with serum levels of amylase remain elevated after clinical remission of pancreatitis.
The fluid collection is found on Imaging studies to be well circumscribed and usually round or oval.
Typically the fluid accumulation is extra pancreatic and has no solid components but is a homogeneous fluid density.
Endoscopic ultrasound reveals a hypoechoic fluid collection surrounded by a thick rim.
Aspiration of the cyst reveals the fluid to be high in amylase, low in CEA, and free of epithelial cells, however histiocytes and inflammatory cells may be present.
Most lesions resolve spontaneously, however endoscopic and percutaneous drainage is the choice of treatment in large symptomatic lesions.
Surgical drainage is not pref2242ed unless other procedures are not successful.
Percutaneous drainage has a high short term success rate, but it is associated with 29% risk of complications and marked discomfort for the patient.
Endoscopic drainage is generally pref2242ed.