History

No specific set of symptoms is pathognomic of pseudocysts; however, consider the possibility of a pseudocyst in a patient who has persistent abdominal pain, anorexia, or an abdominal mass after an episode of pancreatitis.

Rarely, patients present with jaundice or sepsis from an infected pseudocyst.

Pleural effusion is also a common finding.

Physical Examination

The sensitivity of physical examination findings is limited. Patients very frequently have a tender abdomen. Patients occasionally have a palpable mass in the abdomen.

Peritoneal signs suggest rupture of the cyst or infection.

Other possible findings include the following:

Fever
Scleral icterus
Pleural effusion

Complications

Bleeding is the most feared complication and is caused by the erosion of the pseudocyst into a vessel. Consider the possibility of bleeding in any patient who has a sudden increase in abdominal pain coupled with a drop in hematocrit level or a change in vital signs. Therapy is emergent surgery or angiography with embolization of the bleeding vessel.

Do not perform a percutaneous or endoscopic drainage procedure under any circumstances in patients with suspected bleeding into a pseudocyst.

Consider the possibility of infection of the pseudocyst in patients who develop fever or an elevated WBC count. Treat infection with antibiotics and urgent drainage.

GI obstruction, manifesting as nausea and vomiting, is an indication for drainage.

The pseudocyst can also rupture. A controlled rupture into an enteric organ occasionally causes GI bleeding. On rare occasions, a profound rupture into the peritoneal cavity causes peritonitis and death.

Differential Diagnoses

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Media Gallery

Three views of a pancreatic pseudocyst noted during endoscopic ultrasound. The concentric rings in the center of the images are produced by the ultrasound transducer in the stomach. The cyst is observed as the large hypoechoic structure adjacent to the transducer.
These photographs show the endoscopic view of transpapillary pseudocyst drainage in a patient with pancreas divisum and a pseudocyst that communicates with the pancreatic duct. The image on the left shows the ampullary area. The middle image shows a wire placed in the minor papilla into the dorsal pancreatic duct. The right image shows a stent in place in the minor papilla.

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Pancreatic Pseudocysts Clinical Presentation

History

Physical Examination

Complications

References

Tables

Contributor Information and Disclosures

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