Atypical pancreatic pseudocysts.

The authors present three cases of atypical pancreatic pseudocysts, occurring in the course of chronic pancreatitis: intrasplenic pseudocyst, pseudocyst in the hilus of spleen and bleeding into the pseudocyst of the tail of pancreas. Such cysts are extremely difficult, or even impossible to be recognized by conventional clinical and radiological methods. Located in the parenchyma or in the hilus of spleen, they are formed by means of fistulization along the lienorenal ligament. In every case when the chronic pancreatitis coexists with the splenic cyst, the intrasplenic localization of the pancreatic speudocyst should be taken into consideration. The cyst in the hilus of spleen may imitate intraperitoneal mass and its relation with the pancreas may be recorded angiographically only. Angiography is also the basic diagnostic method in the haemorrhage into the pseudocyst. Bleeding into the pseudocyst has a form of vascular blush appearing during arteriography. The blush increases its intensity and persists after an examination. Early diagnosis in atypical pseudocyst is vital for the patient's fate.