A middle aged man presented with abdominal pain. He had suffered an episode of pancreatitis over 1 year ago.
A cystic space was seen adjacent to the spleen. Scanning through revealed that this communicated with a large cystic lesion that extended inferiorly along the paracolic gutter, adjacent to the spine
Pancreatic pseudocysts can occur anywhere in the abdominal cavity and may cause diagnostic confusion if remote from the presentation of pancreatitis. Although most commonly seen around the pancreas, they may be distant. As in this case, collections around the pancreatic tail may be best seen through the spleen and left flank.
This collection was drained and the fluid contained a very high level of amylase, confirming the diagnosis.