To the Editor.—A rapidly growing, smooth cystic swelling in the epigastrium after blunt injury to the upper abdomen or pancreatitis strongly suggests pancreatic cyst. The other conditions that clinically simulate it are ovarian, omental, mesenteric, hepatic, and splenic cysts; cyst of the Wolffian duct; hydronephrosis; cystic kidney; retroperitoneal tumor; and aneurysm of the aorta or adjoining great vessels. To exclude these, plain x-ray films of the abdomen (posteroanterior view), lateral views after barium swallow, barium enemas, intravenous pyelograms, and arteriograms are frequently needed.
I have noted a physical sign that can help immeasurably in the clinical diagnosis. A Ryle tube is palpated over the lump in the epigastrium in thin patients suffering from pancreatic cyst because it provides the counter force to the palpating hand, and as the cyst enlarges and become tense it pushes the stomach forward.
Top, Abdomen prior to surgery (patient in supine position), showing residual