Mediastinal extension of pancreatic pseudocysts causing portal hypertension

Pancreatic pseudocysts are fluid-filled masses with a pseudo-capsule that appear following a pancreatic injury. Pseudocysts are the most frequent cystic lesions of the pancreas, representing about 85% of all pancreatic cysts. The possible complications of pancreatic pseudocysts include infections, hemorrhage, intestinal stenosis or obstruction, and rupture into nearby organs or the peritoneal/retroperitoneal cavity. However, mediastinal extension of pancreatic pseudocysts with portal hypertension is rare. We present a case of an 18-year-old male with a history of weight loss over a 10-month period, presenting with an abdominal lump, hemoptysis, abdominal pain, and dyspnea. He was diagnosed with large pancreatic pseudocysts that extended into the mediastinum by ultrasonography (US) and contrast-enhanced computed tomography (CT) examination. Portal hypertension occurs as a result of portal vein compression. A histopathological examination proved conclusive of pancreatic pseudocysts. The patient was treated with surgery, where the cyst was drained.