A pancreatic pseudocyst-portal vein fistula (PPVF)

Findings suggestive of ‘acute on chronic pancreatitis’ predominantly involving the head.

Marked peripancreatic phlegmonous soft tissue predominantly around the head causing mild widening of the duodenal C loop.

An approximately 7.3 x 4 x 2.8 cm unilocular thin walled non-enhancing branching elongated cystic lesion (pseudocyst1) involving the pancreatic neck, extending superiorly along the subcapsular space of caudate lobe of liver as well as posteromedial perihepatic – subphrenic space.

Another elongated smaller pseudocyst2 involving pancreatic tail measuring 2.5 x 1 cm extending into the retropancreatic space with surrounding mesenteric fat stranding.

Extensive fluid attenuation filling defect involving the main portal vein, right and left branches causing venous distension as described – suggestive of pancreatic pseudocyst – portal vein fistula ( PPVF)

Multiple tortuous portosystemic collateral vessels as described above.

Cholelithiasis.

Mild splenomegaly .