Mediastinal pseudocyst with pericardial effusion and dysphagia treated by endoscopic drainage.

Context: Pancreatic pseudocysts located in the mediastinum are rare. Symptomatic mediastinal pseudocysts can present with dysphagia, dyspnea, airway obstruction and/or cardiac tamponade. Generally, the standard approaches are surgery and external drainage. Recently, there have been many reports of successful endoscopic drainage mainly using a transpapillary technique. However, there have only been a handful of reports involving successful transmural drainage of mediastinal pseudocysts.

Case Report: We report a case of a mediastinal pseudocyst developed after a severe blunt trauma. The patient presented with orthopnea and dysphagia. Multidetector computerized scanning of the abdomen and thorax revealed a thin, cystic, low-attenuation mass in the posterior mediastinum associated with compression of the esophagus and significant pericardial effusion. An endoscopic retrograde pancreatogram demonstrated a normal size pancreatic duct with an extravasation of contrast from the tail of the pancreas into the cyst. Ultimately, the cyst was successfully drained trough gastric fundus.

Conclusion: Symptomatic mediastinal pseudocysts communicating with the pericardial sac can be successfully drained using a transmural endoscopic approach without the need for surgery or external drainage.