Pseudocysts are like

cyst A cyst is a closed sac, having a distinct envelope and division compared with the nearby tissue. Hence, it is a cluster of cells that have grouped together to form a sac (like the manner in which water molecules group together to form a bubb ...

s, but lack

epithelial Epithelium or epithelial tissue is a thin, continuous, protective layer of cells with little extracellular matrix. An example is the epidermis, the outermost layer of the skin. Epithelial ( mesothelial) tissues line the outer surfaces of man ...

or endothelial cells. Initial management consists of general supportive care.

Symptom Signs and symptoms are diagnostic indications of an illness, injury, or condition. Signs are objective and externally observable; symptoms are a person's reported subjective experiences. A sign for example may be a higher or lower temperature ...

s and complications caused by pseudocysts require

surgery Surgery is a medical specialty that uses manual and instrumental techniques to diagnose or treat pathological conditions (e.g., trauma, disease, injury, malignancy), to alter bodily functions (e.g., malabsorption created by bariatric surgery s ...

Computed tomography A computed tomography scan (CT scan), formerly called computed axial tomography scan (CAT scan), is a medical imaging technique used to obtain detailed internal images of the body. The personnel that perform CT scans are called radiographers or ...

(CT) scans are used for initial imaging of cysts, and endoscopic ultrasounds are used in differentiating between cysts and pseudocysts. Endoscopic drainage is a popular and effective method of treating pseudocysts. This is not to be confused with the so-called "pseudocystic appearance", mainly radiographically, of other lesions, such as

Stafne static bone cyst The Stafne defect (also termed Stafne's idiopathic bone cavity, Stafne bone cavity, Stafne bone cyst (misnomer), lingual mandibular salivary gland depression, lingual mandibular cortical defect, latent bone cyst, or static bone cyst) is a depre ...

and

aneurysmal bone cyst Aneurysmal bone cyst (ABC) is a non-cancerous bone tumor composed of multiple varying sizes of spaces in a bone which are filled with blood. The term is a misnomer, as the lesion is neither an aneurysm nor a cyst. It generally presents with ...

of the jaws.

Signs and symptoms

Pseudocysts are often

asymptomatic Asymptomatic (or clinically silent) is an adjective categorising the medical conditions (i.e., injuries or diseases) that patients carry but without experiencing their symptoms, despite an explicit diagnosis (e.g., a positive medical test). P ...

. Symptoms are more common in larger pseudocysts, though the size and time present usually are poor indicators of potential complications. Pancreatic pseudocysts may cause

abdominal pain Abdominal pain, also known as a stomach ache, is a symptom associated with both non-serious and serious medical issues. Since the abdomen contains most of the body's vital organs, it can be an indicator of a wide variety of diseases. Given th ...

nausea Nausea is a diffuse sensation of unease and discomfort, sometimes perceived as an urge to vomit. It can be a debilitating symptom if prolonged and has been described as placing discomfort on the chest, abdomen, or back of the throat. Over 30 d ...

and

vomiting Vomiting (also known as emesis, puking and throwing up) is the forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose. Vomiting can be the result of ailments like food poisoning, gastroenteritis, pre ...

, a bloated feeling, and trouble eating or digesting food. They also may become infected, rupture, or block part of the

intestine The gastrointestinal tract (GI tract, digestive tract, alimentary canal) is the tract or passageway of the digestive system that leads from the mouth to the anus. The tract is the largest of the body's systems, after the cardiovascular system. T ...

. Rarely, the infected pseudocyst causes

jaundice Jaundice, also known as icterus, is a yellowish or, less frequently, greenish pigmentation of the skin and sclera due to high bilirubin levels. Jaundice in adults is typically a sign indicating the presence of underlying diseases involving ...

sepsis Sepsis is a potentially life-threatening condition that arises when the body's response to infection causes injury to its own tissues and organs. This initial stage of sepsis is followed by suppression of the immune system. Common signs and s ...

. Mediastinal pseudocysts, a rare form of pancreatic pseudocysts in the abdomen, may cause

dysphagia Dysphagia is difficulty in swallowing. Although classified under " symptoms and signs" in ICD-10, in some contexts it is classified as a condition in its own right. It may be a sensation that suggests difficulty in the passage of solids or l ...

dyspnea Shortness of breath (SOB), known as dyspnea (in AmE) or dyspnoea (in BrE), is an uncomfortable feeling of not being able to breathe well enough. The American Thoracic Society defines it as "a subjective experience of breathing discomfort that ...

, airway obstruction, or

cardiac tamponade Cardiac tamponade, also known as pericardial tamponade (), is a compression of the heart due to pericardial effusion (the build-up of pericardial fluid in the pericardium, sac around the heart). Onset may be rapid or gradual. Symptoms typically i ...

. Adrenal pseudocysts may cause abdominal pain, along with various gastrointestinal symptoms such as

, and

constipation Constipation is a bowel dysfunction that makes bowel movements infrequent or hard to pass. The Human feces, stool is often hard and dry. Other symptoms may include abdominal pain, bloating, and feeling as if one has not completely passed the ...

Cause

Pancreatic pseudocysts are often caused by acute or chronic

pancreatitis Pancreatitis is a condition characterized by inflammation of the pancreas. The pancreas is a large organ behind the stomach that produces digestive enzymes and a number of hormone A hormone (from the Ancient Greek, Greek participle , "se ...

. They may also be caused by trauma to the abdomen, with a higher frequency in children. Pseudocysts are more often present in chronic pancreatitis patients than acute pancreatitis patients. Also, if the pancreatitis is alcohol induced, there is a higher incidence of pseudocysts. These alcohol-related pseudocysts account for 59%-78% of all pancreatic pseudocysts. Actual pancreatic pseudocyst incidence is small, at around 1.6%-4.5%, or .5-1 per 100,000 adults per year. Types of adrenal cysts include parasitic cysts, epithelial cysts, endothelial cysts, and pseudocysts. 56% of all adrenal cyst-like changes are pseudocysts, and only 7% of those pseudocysts are malignant or potentially

malignant Malignancy () is the tendency of a medical condition to become progressively worse; the term is most familiar as a characterization of cancer. A ''malignant'' tumor contrasts with a non-cancerous benign tumor, ''benign'' tumor in that a malig ...

. The cause of adrenal pseudocysts is unknown. A few theories exist, but it is believed that repeated episodes of trauma, infection, or bleeding may cause collagen formation leading to the formation of a fibrous lining. Retinal pseudocysts may be related to geographic atrophy. A study found that 22% of eyes with geographic atrophy contained pseudocysts. In American trypanosomiasis ( Chagas’ disease), the

parasite Parasitism is a Symbiosis, close relationship between species, where one organism, the parasite, lives (at least some of the time) on or inside another organism, the Host (biology), host, causing it some harm, and is Adaptation, adapted str ...

Trypanosoma cruzi ''Trypanosoma cruzi'' is a species of parasitic euglenoids. Among the protozoa, the trypanosomes characteristically bore tissue in another organism and feed on blood (primarily) and also lymph. This behaviour causes disease or the likelihood ...

'' forms pseudocysts, particularly within muscular and neurological tissue. Within these pseudocysts the parasites enter their amastigote stage, reproducing asexually, before rupturing from the pseudocyst and entering the bloodstream.

Diagnosis

Description

A pseudocyst is a cystic lesion that may appear as a cyst on scans, but lacks epithelial or endothelial cells. An acute pancreatic pseudocyst is made of pancreatic fluids with a wall of fibrous tissue or granulation. Pseudocysts may form in a number of places, including the

pancreas The pancreas (plural pancreases, or pancreata) is an Organ (anatomy), organ of the Digestion, digestive system and endocrine system of vertebrates. In humans, it is located in the abdominal cavity, abdomen behind the stomach and functions as a ...

abdomen The abdomen (colloquially called the gut, belly, tummy, midriff, tucky, or stomach) is the front part of the torso between the thorax (chest) and pelvis in humans and in other vertebrates. The area occupied by the abdomen is called the abdominal ...

adrenal gland The adrenal glands (also known as suprarenal glands) are endocrine glands that produce a variety of hormones including adrenaline and the steroids aldosterone and cortisol. They are found above the kidneys. Each gland has an outer adrenal corte ...

, and

eye An eye is a sensory organ that allows an organism to perceive visual information. It detects light and converts it into electro-chemical impulses in neurons (neurones). It is part of an organism's visual system. In higher organisms, the ey ...

Pancreatic pseudocysts

The most common and effective method of diagnosing a pancreatic pseudocyst is with a

CT scan A computed tomography scan (CT scan), formerly called computed axial tomography scan (CAT scan), is a medical imaging technique used to obtain detailed internal images of the body. The personnel that perform CT scans are called radiographers or ...

. A pseudocyst generally appears as a fluid-filled mass. In some instances, other methods must be used to distinguish between a normal cyst and a pseudocyst. This is usually accomplished with endoscopic ultrasound or with

fine needle aspiration Fine-needle aspiration (FNA) is a diagnostic procedure used to investigate lumps or masses. In this technique, a thin (23–25 gauge (0.52 to 0.64 mm outer diameter)), hollow needle is inserted into the mass for sampling of cells that, ...

. Transabdominal ultrasound can be used to identify pseudocysts, which appear on the scan as echoic structures associated with distal acoustic enhancement. They tend to be round and enclosed in a smooth wall. Pseudocysts may appear more complex when young, hemorrhaged, or when complicated due to infection. The transabdominal ultrasound has a sensitivity rate in detection of pancreatic pseusocysts of 75%-90%, making it inferior to a CT scan, which has a rate of 90%-100%.

CT scans A computed tomography scan (CT scan), formerly called computed axial tomography scan (CAT scan), is a medical imaging technique used to obtain detailed internal images of the body. The personnel that perform CT scans are called radiographers or ...

are more accurate, and provide more detail regarding the pseudocyst and its surroundings. The CT scan's weakness is its lack of differentiation between pseudocysts and cystic neoplasm. Also, the

intravenous Intravenous therapy (abbreviated as IV therapy) is a medical technique that administers fluids, medications and nutrients directly into a person's vein. The intravenous route of administration is commonly used for rehydration or to provide nutr ...

contrast given at the time of the CT scan may worsen kidney dysfunction.

MRI Magnetic resonance imaging (MRI) is a medical imaging technique used in radiology to generate pictures of the anatomy and the physiological processes inside the body. MRI scanners use strong magnetic fields, magnetic field gradients, and rad ...

and MRCP are effective methods of detecting pseudocysts, but are not regularly used because CT scans offer most of the needed information. These scans do, however, provide better contrast, which allows for better characterization of fluid collections, depicting debris within the collections, and detection of bleeding. Endoscopic ultrasound is generally used as a secondary test to further evaluate the cysts found in other tests, and is used when determining if a cyst is a pseudocyst or not.

Adrenal pseudocysts

Adrenal pseudocysts are found in much the same way as pancreatic pseudocysts, with CT scans. In addition, adrenalectomies are used to diagnose the lesion and sometimes relieve pain.

Prevention

Because pseudocysts are closely related to other conditions, such as

and alcohol use, the prevention of pseudocysts lies in the prevention of the main problem.

Treatment

Not all cysts require treatment. Many pancreatic pseudocysts improve and disappear by themselves. If the cysts are small and are not causing symptoms, careful observation with periodic CT scans is often done. Pseudocysts that persist over many months or that cause symptoms require treatment. Supportive medical care used to help small pseudocysts go away includes the use of

fluids,

analgesics An analgesic drug, also called simply an analgesic, antalgic, pain reliever, or painkiller, is any member of the group of drugs used for pain management. Analgesics are conceptually distinct from anesthetics, which temporarily reduce, and in s ...

, and antiemetics. Doctors often recommend a low-fat diet for those who can tolerate oral intake.

Surgery Surgery is a medical specialty that uses manual and instrumental techniques to diagnose or treat pathological conditions (e.g., trauma, disease, injury, malignancy), to alter bodily functions (e.g., malabsorption created by bariatric surgery s ...

is usually required in the treatment of pseudocysts with

symptoms Signs and symptoms are diagnostic indications of an illness, injury, or condition. Signs are objective and externally observable; symptoms are a person's reported subjective experiences. A sign for example may be a higher or lower temperature ...

or complications. There are three main methods for draining a pancreatic pseudocyst: endoscopic drainage,

percutaneous {{More citations needed, date=January 2021 In surgery, a percutaneous procedurei.e. Granger et al., 2012 is any medical procedure or method where access to inner organs or other tissue is done via needle-puncture of the skin, rather than by using ...

catheter In medicine, a catheter ( ) is a thin tubing (material), tube made from medical grade materials serving a broad range of functions. Catheters are medical devices that can be inserted in the body to treat diseases or perform a surgical procedure. ...

drainage, or

open surgery Minimally invasive procedures (also known as minimally invasive surgeries) encompass surgical techniques that limit the size of incisions needed, thereby reducing wound healing time, associated pain, and risk of infection. Surgery by definitio ...

. Endoscopic drainage tends to be the preferred method due to it being less invasive and having a high long-term success rate. Percutaneous drainage involves the guidance of a

ultrasound Ultrasound is sound with frequency, frequencies greater than 20 Hertz, kilohertz. This frequency is the approximate upper audible hearing range, limit of human hearing in healthy young adults. The physical principles of acoustic waves apply ...

. A drainage

is placed into the fluid cavity to drain the fluid, which is then collected over several weeks into an external collection system. The catheter is removed when the drainage becomes minimal. Once the catheter is removed, contrast is injected into the cyst cavity to determine the remaining size and to monitor progress. The success rate is around 50%, and the unsuccessful drainages are mostly caused by large ductal leaks or blockage of the main pancreatic duct. This method is not recommended when patients cannot manage a catheter at home or with patients whose cysts contain bloody or solid material. Surgical drainage of a pseudocyst involves creating a pathway between the pseudocyst cavity and the stomach or small bowel. This method is generally only used if the patient cannot tolerate or failed percutaneous or endoscopic drainage. This method is more risky than the others. Endoscopic drainage is becoming the preferred method of draining pseudocysts because it is less invasive, does not require external drain, and has a large long-term success rate. Drainage is usually achieved with a transpapillary approach with ERCP. Sometimes a direct drainage across the

stomach The stomach is a muscular, hollow organ in the upper gastrointestinal tract of Human, humans and many other animals, including several invertebrates. The Ancient Greek name for the stomach is ''gaster'' which is used as ''gastric'' in medical t ...

or duodenal wall is used instead. The transpapillary approach is used when the pseudocyst is in communication with the main pancreatic duct, and is also successful in patients with pancreatic duct disruption. Transgastric or transduodenal approaches are used when the pseudocyst is next to the gastro-duodenal wall. Endoscopic ultrasound is the most commonly used test to gather the needed information about the pseudocyst for this method. The endoscopic method depends on the presence of a bulge into the stomach or duodenum to determine the site for catheterization. Inherent risks include missing the pseudocyst, injuring nearby vessels, and inefficient placement of the catheter. In patients with chronic pseudocysts, this approach has a 90% success rate. Recurrence after drainage is around 4%, and the complication rate is below 16%. To treat adrenal pseudocysts, an adrenalectomy or laproscopy may be used.

References

External links

{{Tumors Gross pathology