Empyema associated with rupture of mediastinal pancreatic pseudocyst: A case report

Abstract

A 60-year-old man with a history of chronic alcoholic pancreatitis was referred to us for progressive dyspnea. Computed tomography (CT) revealed large bilateral pleural effusion and a cystic lesion in the posterior mediastinal compartment extending to the retroperitoneal cavity through the esophageal hiatus. The pleural effusion had a high amylase content. We diagnosed the patient with mediastinal pancreatic pseudocyst and pancreatic pleural effusion, which was treated with medication and drainage of the effusion. After two weeks, the inflammatory response gradually increased, and a follow-up CT showed that the left pleural effusion was resistant to conservative treatment, although the mediastinal pancreatic pseudocyst had disappeared. Empyema due to rupture of the mediastinal pancreatic pseudocyst was suspected. Therefore, emergency video-assisted thoracoscopic surgery was performed for debridement and drainage of the thoracic and mediastinal cavities. Post-treatment CT images showed that the inflammatory response had decreased, and the effusion had disappeared. The patient recovered uneventfully, without the appearance of another pseudocyst in the abdominal cavity. Because mediastinal pancreatic pseudocysts are resistant to medical treatment and likely to cause critical pulmonary complications, intensive follow-up should be performed to minimize or prevent chest complications, and appropriate surgical or interventional treatment should be performed.