Research Article Mediastinal Pseudocyst: Varied Presentations and Management—Experience from a Tertiary Referral Care Centre in India Durairaj Segamalai, Abdul Rehman Abdul Jameel, Naveen Kannan, Amudhan Anbalagan, Benet Duraisamy, Prabhakaran Raju, and Kannan Devy Gounder Institute of Surgical Gastroenterology, Madras Medical College, Chennai 600003, India Correspondence should be addressed to Kannan Devy Gounder; malarkan08@gmail.com Received 22 September 2016; Revised 1 February 2017; Accepted 26 February 2017; Published 14 March 2017 Academic Editor: Richard Charnley Copyright © 2017 Durairaj Segamalai et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Pseudocysts are a recognised complication following acute or chronic pancreatitis. Usually located in peripancreatic areas, they have also been reported to occur in atypical regions like liver, pelvis, spleen, and mediastinum. Mediastinal pseudocysts are a rare entity and present with myriad of symptoms due to their unique location. Tey are a clinical challenge to diagnose and manage. In this paper, we describe the clinical and radiological characteristics of mediastinal pseudocysts in 7 of our patients, as well as our experience in managing these patients along with their clinical outcome. 1. Introduction Pancreatic pseudocysts are common fndings in patients with acute or chronic pancreatitis, usually located in peri- pancreatic areas. Mediastinal pseudocyst is rare and ofen reported as case reports, exact incidence being unknown [1]. Pancreatic ductal disruption due to infammatory injury leads to leakage of amylase rich pancreatic secretions along the paths of least resistance. Posterior disruptions can lead to thoracopancreatic fstulae while anterior disruptions produce pancreatic ascites. Toracopancreatic fstulas are divided into four types based on the termination site of the fstula: pancre- aticopleural, mediastinal pseudocyst, pancreaticobronchial, and pancreaticopericardial. Mediastinal pseudocyst by way of its unique location can present with myriad symptoms like dysphagia, chest pain, or palpitations and in extreme cases pericardial efusion, tamponade, and respiratory dis- tress [2]. It can be a diagnostic and therapeutic challenge. High index of suspicion is ofen needed in diagnosing this entity. Pancreatic ductal morphology and its communication with the pseudocyst hold the key for successful manage- ment. We present our experience in managing mediastinal pseudocysts. 2. Materials and Methods Tis study is a retrospective analysis of patients diagnosed to have mediastinal pseudocyst between Jan 2010 and March 2016 at our Institute. Our Institute is a high volume tertiary referral care centre in India, where more than 200 pan- creatic surgeries are performed annually for various benign and malignant disorders. We reviewed clinical records and imaging database and were able to identify 7 patients with mediastinal pseudocyst. Torough analysis regarding their clinical symptomatology, etiology of pancreatitis, radiological features, supplementary investigations, management strategy, and their follow-up was done. Basic laboratory investigation including serum amylase, lipase, and c-reactive protein was done. All patients underwent oesophagogastroduodenoscopy (OGD), ultrasound (USG) with portal Doppler, contrast enhanced computed tomography (CT) scan of abdomen and chest, and other investigations like echocardiogram, barium swallow, and magnetic resonance cholangiopancreatography (MRCP) as required. Patient presenting with ascites or pleural efusion underwent aspiration and biochemical fuid analysis. Patients who had dysphagia were graded as per dysphagia score of Knyrim et al. [3]; grade 0 denoted the Hindawi HPB Surgery Volume 2017, Article ID 5247626, 7 pages https://doi.org/10.1155/2017/5247626