Volume 3, Issue 5, Pages (May 2018)

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Volume 3, Issue 5, Pages 162-165 (May 2018) Endoscopic management of pancreatic duct disruption with large mediastinal pseudocyst Vivian Ortiz, MD, Muhammad Nadeem Yousaf, MD, Thiruvengadam Muniraj, MD, Priya Jamidar, MD, Harry R. Aslanian, MD VideoGIE Volume 3, Issue 5, Pages 162-165 (May 2018) DOI: 10.1016/j.vgie.2018.01.013 Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 1 CT transverse plane view demonstrating steatotic liver and atrophic pancreas with multiple calcifications consistent with chronic pancreatitis. VideoGIE 2018 3, 162-165DOI: (10.1016/j.vgie.2018.01.013) Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 2 CT transverse plane view of the pancreatic pseudocyst in the mediastinum measuring 10 cm × 7 cm × 7 cm near the diaphragmatic hiatus. Bilateral pleural fluid is demonstrated, larger on the right side. VideoGIE 2018 3, 162-165DOI: (10.1016/j.vgie.2018.01.013) Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 3 CT transverse plane view of the pancreatic pseudocyst at the level of aortic arch and T4 vertebral body. Bilateral pleural fluid collection is seen, larger on the right side. VideoGIE 2018 3, 162-165DOI: (10.1016/j.vgie.2018.01.013) Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 4 CT sagittal plane view of the pancreatic pseudocyst, demonstrating extension of fluid collection to mediastinum. VideoGIE 2018 3, 162-165DOI: (10.1016/j.vgie.2018.01.013) Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 5 Pancreatic pseudocyst turbid aspirate. VideoGIE 2018 3, 162-165DOI: (10.1016/j.vgie.2018.01.013) Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 6 Soehendra stent retriever. VideoGIE 2018 3, 162-165DOI: (10.1016/j.vgie.2018.01.013) Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 7 CT abdomen transverse plane view 4 months after ERCP stent placement, showing no pancreatic pseudocyst emerging from pancreas. Hepatic steatosis is notable, but no pleural effusion is noted. VideoGIE 2018 3, 162-165DOI: (10.1016/j.vgie.2018.01.013) Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 8 CT transverse plane view of mediastinum 4 months after ERCP pancreatic duct stent placement, showing resolution of mediastinal pancreatic pseudocyst and near-resolution of bilateral pleural fluid collections. VideoGIE 2018 3, 162-165DOI: (10.1016/j.vgie.2018.01.013) Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 9 Algorithmic approach to management of symptomatic large fluid collection suspected to originate from a PD disruption. LAMS, lumen-apposing metal stent; PD, pancreatic duct. VideoGIE 2018 3, 162-165DOI: (10.1016/j.vgie.2018.01.013) Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions