Congestive heart failure due to a pancreatic pseudocyst

BACKGROUND Mediastinal extension of pancreatic pseudocysts has caused rare cases of cardiac compression, but to our knowledge, congestive heart disease due to cardiac compression by a pancreatic pseudocyst has never been reported.

SUMMARY A 48-year-old man presented with dyspnea, swelling of both lower limbs, left-sided chest pain, and colicky, nonradiating epigastric pain. Computed tomography of the abdomen and lower thorax revealed a huge cystic mass directly behind the heart, extending through the esophageal hiatus into the abdomen. The patient subsequently noted dysphagia and epigastric pain and began vomiting after meals. Radiography of the upper gastrointestinal system with barium contrast confirmed that the lower end of the esophagus and the right and lower portions of the stomach were extrinsically compressed. Complete recovery followed surgical removal and internal drainage of a large pancreatic pseudocyst.

CONCLUSIONS Mediastinal extension of a pancreatic pseudocyst can cause cardiac compression, leading to congestive heart failure.