CYSTIC LESIONS OF THE PANCREAS IN ACUTE PANCREATITIS MAY NOT BE PSEUDOCYSTS

Background: The distinction between pseudocysts and pancreatic cystic neoplasms is often predicated upon a history of pancreatitis. In the absence of pancreatitis, cystic lesions of the pancreas should not be interpreted as pseudocysts, whereas in the setting of pancreatitis, cystic lesions are usually interpreted as pseudocysts. Methods: We have reviewed our experience with cystic neoplasms of the pancreas associated with acute pancreatitis. We identified five patients with pancreatic cystic neoplasms associated with recurrent pancreatitis (median: 3 episodes, range: 3-6), which were initially interpreted clinically as pseudocysts. We reviewed their clinical records and radiographs to assist in this distinction. Results: In two of the patients, the cystic lesion was visualized on imaging at the first episode of pancreatitis. In the remaining three, the lesion was not identified until a subsequent episode. Review of the radiographic features of the lesions revealed characteristic features of pancreatic cystic neoplasms in all five, including: communication with the pancreatic ductA, parenchymal location of the lesionB, multilocular appearanceC and presence of a thick capsule.D The following Table summarizes the findings of the five patients:TABLEConclusion: The presence of a cystic lesion at the initial episode of acute pancreatitis should raise concern for a pancreatic cystic neoplasm. Characteristic radiographic features help to differentiate pseudocysts from cystic neoplasms.