[Dysphagia as the leading symptom: presentation of a rare course in chronic pancreatitis with formation of pseudocysts].

Pancreatic pseudocysts are a common complication of pancreatitis. Although 20% regress spontaneously, persistent pseudocysts may lead to various complications such as infection, bleeding or compression of adjacent structures or organs. Due to the barrier function of the diaphragm, infection of pancreatic pseudocysts with posterior mediastinal extension represents a rare entity. Because of the rareness and untypical symptoms of such events, a mediastinal extension of an infected pancreatic pseudocyst often ist not recognized. In our case the expansion of the infection to the mediastinum had led to a compression of the distal esophagus. Preoperative diagnostic evaluation was highly suggestive for a malignant distal esophageal tumor. A laparotomy was performed to further elucidate the origin of the mass. Intraoperative findings showed a pancreatic pseudocyst with infiltrative extension of an infection from retrogastral to the lower mediastinum. After histologic preparations from intraoperative tissue samples had ruled out malignancy, we performed a cystojejunostomy of the pseudocyst and partial resection of the infected surrounding tissue. Mediastinal masses with chronic pancreatitis should raise suspicion for extension of pancreatitis to the mediastinum. In our opinion, for this course of chronic pancreatitis operative intervention represent the standard for therapy.