An unusual neck swelling: Extension of mediastinal pseudocys
Case Report
A 35-year-old male presented with a history of painless swelling on the right side of the neck of 2 weeks duration. The patient also had progressively increasing painless dysphagia and dry cough with no dyspnea. He had history of significant alcohol consumption. Clinical examination revealed a cystic swelling in the right lateral part of the neck. Contrast enhanced computed tomography (CECT) of the chest and abdomen revealed a hypodense collection measuring 2.5 cm size in the neck that was communicating with a large collection measuring 8 cm in the mediastinum around the trachea. Also noted was the presence of left-sided pleural effusion and calcification in the uncinate and head of the pancreas. The main pancreatic duct was not dilated. The serum amylase level was elevated (460 IU/L). Endoscopic ultrasound (EUS) revealed changes of chronic calcific pancreatitis with an anechoic periesophageal collection suggestive of mediastinal pseudocyst. The patient was started on pancreatic enzyme supplementation and subcutaneous octreotide. The patient had gradual improvement and his neck swelling subsided in 2 weeks, and the dysphagia was alleviated. The patient was discharged and was found to be asymptomatic after 3 months of follow-up.