Mediastinal Pseudocyst and Cardiac Tamponade Due to Massive Pericardial Effusion in Pediatric Chronic Calcific Pancreatitis

Abstract

A 7-year-old male patient with a history of recurrent abdominal pain over 1 year presented with cardiac tamponade due to massive pericardial effusion, which was percutaneously drained. Contrast-enhanced computed tomography revealed a large posterior mediastinal cyst and calcified, heterogeneous pancreatic parenchyma. Elevated amylase and lipase levels of the cyst fluid confirmed the diagnosis of pancreatic pseudocyst, which was treated with an octreotide infusion and Roux-en-Y cystojejunostomy. The child was discharged on pancreatic enzyme supplement and was asymptomatic on follow-up.

Keywords

chronic calcific pancreatitis - mediastinal pancreatic pseudocyst - cardiac tamponade - Roux-en-Y cystojejunostomy

• References

• 1 Werlin SL, Wilschanski M. Chronic pancreatitis. In Stanton BF, St Geme JW, Schor NF, Behrman RE. eds. Nelson Textbook of Pediatrics (First South Asia Edition). 20th ed. New Delhi, India: Reed Elsevier India Pvt. Ltd; 2015: 1915-1917
• 2 Gupta R, Munoz JC, Garg P, Masri G, Nahman Jr NS, Lambiase LR. Mediastinal pancreatic pseudocyst—a case report and review of the literature. MedGenMed 2007; 9 (02) 8
• 3 Bhatt VR, Koirala A, Wetz RV, Kedia S, Ghimire P, Bartaula R. Cardiac tamponade in acute pancreatitis. BMJ Case Rep 2011; 2011 (11) bcr0820103287
• 4 Galligan JJ, Williams HJ. Pancreatic pseudocysts in childhood. Unusual case with mediastinal extension. Am J Dis Child 1966; 112 (05) 479-482
• 5 Poddar B, Singh K, Kochar S, Parmar VR, Dhiman P. Pancreatopleural fistula presenting as hemorrhagic pleural effusion. Indian Pediatr 1999; 36 (03) 310-313
• 6 Bongiovi JJ, Logosso RD. Pancreatic pseudocyst occurring in the battered child syndrome. J Pediatr Surg 1969; 4 (02) 220-226
• 7 Visrutaratna P, Ukarapol N. Clinical image. Mediastinal pancreatic pseudocyst in chronic pancreatitis. Pediatr Radiol 2010; 40 (07) 1298
• 8 Xu H, Zhang X, Christe A. , et al. Anatomic pathways of peripancreatic fluid draining to mediastinum in recurrent acute pancreatitis: visible human project and CT study. PLoS ONE 2013; 8 (04) e62025
• 9 Kayar Y, Turkdogan KA, Baysal B. , et al. Concurrent acute pancreatitis and pericardial effusion. Pan Afr Med J 2015; 21: 122
• 10 Tan MH, Kirk G, Archibold P, Kennedy P, Regan MC. Cardiac compromise due to a pancreatic mediastinal pseudocyst. Eur J Gastroenterol Hepatol 2002; 14 (11) 1279-1282
• 11 Cooney DR, Crosfeld JL. Operative management of pancreatic pseudocysts in infants and children: a review of 75 cases. Ann Surg 1975; 182 (05) 590-596
• 12 Kamble RS, Gupta R, Gupta AR. , et al. Thoracoabdominal pseudocyst of pancreas: An rare location, managed by retrocolic retrogastric Roux-en-Y cystojejunostomy. World J Gastrointest Surg 2015; 7 (05) 82-85
• 13 Parekh PJ, Howerton D, Johnson DA. Not your everyday case of acute pancreatitis: a rare complication of a common diagnosis. ACG Case Rep J 2013; 1 (01) 40-43
• 14 Aggarwal S, Garg R, Bansal P. Idiopathic chronic calcific pancreatitis in a child: An uncommon entity. J Nat Sci Biol Med 2013; 4 (01) 230-232
• 15 Bhasin DK, Singh G, Rana SS. , et al. Clinical profile of idiopathic chronic pancreatitis in North India. Clin Gastroenterol Hepatol 2009; 7 (05) 594-599
• 16 Midha S, Khajuria R, Shastri S, Kabra M, Garg PK. Idiopathic chronic pancreatitis in India: phenotypic characterisation and strong genetic susceptibility due to SPINK1 and CFTR gene mutations. Gut 2010; 59 (06) 800-807
• 17 Paliwal S, Bhaskar S, Mani KR. , et al. Comprehensive screening of chymotrypsin C (CTRC) gene in tropical calcific pancreatitis identifies novel variants. Gut 2013; 62 (11) 1602-1606