CTICasesEsophageal-Pancreatic Pseudocyst Fistula
Imaging findings
Non-contrast CT in a patient with chronic pancreatitis demonstrates esophageal wall thickening and an abnormal mediastinal gas collection. Contrast-enhanced abdominal CT shows a retrogastric pancreatic pseudocyst tracking into the lower mediastinum. An esophagram demonstrates a subtle tract of contrast material extravasating from the lower esophagus into the adjacent right lower lobe lung parenchyma, indicating a fistula.
Key takeaways
Pancreatic pseudocysts containing active digestive enzymes can track superiorly into the mediastinum and erode into adjacent structures. Erosion into the esophagus leads to an esophageal-pancreatic pseudocyst fistula, which can cause recurrent aspiration, mediastinitis, and focal lung consolidation.
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