Review Question - QID 101125

The patient’s symptoms are consistent with chronic pancreatitis, and imaging suggests a pancreatic pseudocyst. Pancreatic pseudocysts can present as palpable upper abdominal masses upon physical exam.

Pancreatic pseudocysts are associated with chronic pancreatitis, acute pancreatitis, and severe chest trauma. Afflicted patients may present with abdominal pain and a palpable abdominal mass. Unlike true cysts, pancreatic pseudocysts lack epithelium and are lined with granulation tissue and fibrosis. Most pseudocysts resolve spontaneously. Treatment, when necessary, is with surgery or IR-guided drainage.

Nair et al. review chronic pancreatitis. The average age of diagnosis is 35-55 years and alcoholism plays a significant role in disease formation. Calcifications on CT are pathognomonic. Pseudocyst is a common complication of chronic pancreatitis.

Habashi et al. review pancreatic pseudocysts. Diagnosis is accomplished most often by cross-sectional imaging. Endoscopic ultrasound with fine needle aspiration is the preferred test to distinguish pseudocyst from other cystic lesions of and around the pancreas.

Figure A is a CT scan showing a large, cystic region around the head of the pancreas consistent with pancreatic pseudocyst.

Incorrect Answers:
Answer 2: Dermatitis herpetiformis is a skin rash characterized by prurulent, chronic papulovesicular eruptions. It is associated with celiac sprue.
Answer 3: Acanthosis nigricans is a velvety hyperpigmentation of the skin usually found in body folds. It is associated with several endocrinopathies but not pancreatic pseudocyst.
Answer 4: Splenomegaly is enlargement of the spleen. It is associated with several disorders including infections, portal hypertension, malignancies, and others.
Answer 5: Asterixis is flapping of the wrist during dorsiflexion. It is associated with hepatic encephalopathy.