Pseudocysts involving the left lobe of the liver. CT demonstration

Abstract

The propensity of pancreatic fluid collections to dissect along established tissue planes is well known. Pancreatic pseudocysts have been described in virtually every organ in the body but particular attention has been paid to findings of pseudocysts in the anterior pararenal space, the lesser sac, the spleen, the mediastinum and the perirenal space (Asokan et al, 1977; Warshaw etal, 1972; McAllen, 1977). More recently, the finding of pseudocysts in the left lobe of the liver has been described (Siegelman et al, 1980). We recently had the opportunity of studying two patients with pseudocysts involving the left lobe of the liver. A 55-year-old man, with a heavy alcoholic history, was admitted with sharp chest pain radiating to the left side of the abdomen, vomiting, diarrhoea and shortness of breath. Physical examination revealed a distended abdomen with a 5–6 cm tender hepatomegaly. There was generalised abdominal tenderness and guarding, with an impression of a vague mass in the left hypochondrium. The haemoglobin was 11.7 g/dl, white blood cell count 16 100 mm−3, serum amylase 132U and erythrocyte sedimentation rate 90mm/h−1. The results of liver function tests were within normal limits. Abdominal X ray revealed numerous fluid levels and free fluid in the abdomen. Chest X ray showed hyperinflated lung fields and a left pleural effusion. Abdominal sonography revealed ascites and two large cystic collections with debris within them; one was adjacent to, and appeared to involve, the left lobe of the liver; the other was in the lesser sac area.