MDCT manifestations of mediastinal pancreatic pseudocyst mimic hiatus hernia

Mediastinal pancreatic pseudocyst is rarely a complication of pancreatitis. Both the syndrome itself and diagnostic chest radiograph can easily be confused with hiatus hernia. It is a challenge for radiologists to distinguish a mediastinal pancreatic pseudocyst from a mediastinal cystic lesion on CT (computed tomography) axial imaging. Here, we present the case of a 51-year old man with severe epigastralgia, vomiting and nausea. Chest radiograph and axial CT imaging revealed a posterior mediastinal cystic mass which could be mistaken as hiatus hernia. Using MDCT (multidetector computed tomography) coronal and sagittal images, it is easy to distinguish between a mediastinal lesion (e.g., hiatus hernia) and the pancreas, and thus it is possible to distinguish a mediastinal pancreatic pseudocyst.