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Spontaneous pancreatic pseudocyst - superior mesenteric vein fistula: A rare complication of chronic pancreatitis.

ABSTRACT: Pseudocyst formation is common in chronic pancreatitis. A rare subset of these patients may develop fistulization between the pseudocyst and the portal vein system. We report a case of spontaneous pancreatic pseudocyst - superior mesenteric vein fistula in a 61-year-old male with a history of chronic recurrent calcifying pancreatitis. The fistulous connection was correctly identified on both computed tomography and magnetic resonance cholangiopancreatography (MRCP), and the patient was treated successfully with a conservative approach. Our case report aims to educate on this rare and potentially fatal vascular complication of chronic pancreatitis and to discuss the role of modern noninvasive imaging techniques, such as T2-weighted MRI/MRCP, in establishing this diagnosis and making a decision regarding its management.

SUBMITTER: Tomsan H

PROVIDER: S-EPMC7452026 | biostudies-literature | 2020 Oct

REPOSITORIES: biostudies-literature

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Spontaneous pancreatic pseudocyst - superior mesenteric vein fistula: A rare complication of chronic pancreatitis.

Tomsan Hanna H Olivas-Chacon Cristina C Hayeri Mohammad Reza MR Babu Aparna Srinivasa AS

Radiology case reports 20200819 10

Pseudocyst formation is common in chronic pancreatitis. A rare subset of these patients may develop fistulization between the pseudocyst and the portal vein system. We report a case of spontaneous pancreatic pseudocyst - superior mesenteric vein fistula in a 61-year-old male with a history of chronic recurrent calcifying pancreatitis. The fistulous connection was correctly identified on both computed tomography and magnetic resonance cholangiopancreatography (MRCP), and the patient was treated s ...[more]

PMID: 32874387

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Project description:ObjectivesTo develop a radiomics signature for predicting surgical portal vein-superior mesenteric vein (PV-SMV) in patients with pancreatic ductal adenocarcinoma (PDAC) and measure the effect of providing the predictions of radiomics signature to radiologists with different diagnostic experiences during imaging interpretation.MethodsBetween February 2008 and June 2020, 146 patients with PDAC in pancreatic head or uncinate process from two institutions were retrospectively included and randomly split into a training (n = 88) and a validation (n =58) cohort. Intraoperative vascular exploration findings were used to identify surgical PV-SMV invasion. Radiomics features were extracted from the portal venous phase CT images. Radiomics signature was built with a linear elastic-net regression model. Area under receiver operating characteristic curve (AUC) of the radiomics signature was calculated. A senior and a junior radiologist independently review CT scans and made the diagnosis for PV-SMV invasion both with and without radiomics score (Radscore) assistance. A 2-sided Pearson's chi-squared test was conducted to evaluate whether there was a difference in sensitivity, specificity, and accuracy between the radiomics signature and the unassisted radiologists. To assess the incremental value of providing Radscore predictions to the radiologists, we compared the performance between unassisted evaluation and Radscore-assisted evaluation by using the McNemar test.ResultsNumbers of patients identified as presence of surgical PV-SMV invasion were 33 (37.5%) and 19 (32.8%) in the training and validation cohort, respectively. The radiomics signature achieved an AUC of 0.848 (95% confidence interval, 0.724-0.971) in the validation cohort and had a comparable sensitivity, specificity, and accuracy as the senior radiologist in predicting PV-SMV invasion (all p-values > 0.05). Providing predictions of radiomics signature increased both radiologists' sensitivity in identifying PV-SMV invasion, while only the increase of the junior radiologist was significant (63.2 vs 89.5%, p-value = 0.025) instead of the senior radiologist (73.7 vs 89.5%, p-value = 0.08). Both radiologists' accuracy had no significant increase when provided radiomics signature assistance (both p-values > 0.05).ConclusionsThe radiomics signature can predict surgical PV-SMV invasion in patients with PDAC and may have incremental value to the diagnostic performance of radiologists during imaging interpretation.

Dataset Information

Spontaneous pancreatic pseudocyst - superior mesenteric vein fistula: A rare complication of chronic pancreatitis.

Publications

Spontaneous pancreatic pseudocyst - superior mesenteric vein fistula: A rare complication of chronic pancreatitis.

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