European Journal of Radiology Extra 60 (2006) 29–31 Acute pancreatitis complicated by intrasplenic and intrahepatic pseudocysts Shivanand Gamanagatti a,∗ , Harsh Kandpal a , Viplab Mishra b a Department of Radio Diagnosis, All India Institute of Medical Sciences, New Delhi 110029, India b Department of Surgery, All India Institute of Medical Sciences, New Delhi 110029, India Received 28 June 2006; accepted 29 June 2006 Abstract Intrahepatic pseudocyst formation as a complication of acute pancreatitis occurs extremely rarely. Also the penetration or dissection of splenic parenchyma by pancreatic pseudocyst is very rare. The purpose of this paper is to describe the computed tomography (CT) findings of intrahepatic pseudocysts and dissection of splenic parenchyma by pancreatic tail pseudocyst in a 75-year-old patient. © 2006 Published by Elsevier Ireland Ltd. Keywords: Computed tomography; Pseudocyst; Intrahepatic; Intrasplenic 1. Introduction Computed tomography (CT) currently is the most reliable imaging modality for diagnosis and staging of acute pancre- atitis. CT allows detection of potential complications thus optimizing management. Pseudocyst formation is a frequent complication of acute pancreatitis and related to diffusion of activated pancreatic enzymes. Pseudocysts most commonly form into the pancreatic bed but may also extend into the lesser sac, retroperitoneum, and peritoneal cavity [1]. Less usual locations have been reported in the literature [2–5] including: spleen, duodenum, kidney, stomach, common bile duct, and mediastinum. To our knowledge, intrahepatic loca- tion is much rarer [6,7] and also the intrasplenic dissection of pancreatic pseudocysts is extremely rare [8]. 2. Case report A 75-year-old chronic alcoholic male presented to us with acute epigastric pain radiating to the back. Physical ∗ Correspondence to: c/o Vijay Kumar Uppal, 198/58, East of Kailash, Uppal’s House, Ramesh Market, New Delhi 110065, India. Tel.: +91 11 26864851x4889/26412131; fax: +91 11 26862663. E-mail address: shiv223@rediffmail.com (S. Gamanagatti). examination showed a rigid abdomen without guarding. Lab- oratory investigations showed elevated serum amylase and lipase levels; bilirubin level was normal. A contrast-enhanced computed tomography scan demonstrated pseudocyst of the pancreatic tail extending into the splenic hilum which was dissecting through splenic parenchyma (Fig. 1). In addition, there were multiple intrahepatic, hepatic subcapsular, and intrapancreatic pseudocysts identified (Fig. 2). The pancre- atic head was bulky and hypodense. On day 3 of hospital stay, he developed severe tachypnoea and acidotic pattern of breathing. Arterial blood gases (ABG) revealed severe acido- sis. The urine ketones were found to be in large quantity, with a normal random blood sugar. The ketoacidosis persisted for 48 h despite appropriate corrective measures, while the sugar level remained persistently normal. Under ultrasound guid- ance pigtails were placed inside the larger pseudocysts. The amylase level of drained fluid was very high. However, the patient continued to be septic and expired after 10 days of hospital admission. 3. Discussion Intrahepatic pancreatic pseudocysts are a rare complica- tion of acute pancreatitis. Usually, only a single intrahepatic pseudocyst is present, but there may also be multiple col- 1571-4675/$ – see front matter © 2006 Published by Elsevier Ireland Ltd. doi:10.1016/j.ejrex.2006.06.008