Complicated Intramural Gastric Pseudocyst with Hemorrhagic Sequela

Diagnostic Classification

• The American College of Radiology recommends using the primary code K86.3 (Pseudocyst of pancreas) as the base diagnosis, with an additional code for the hemorrhagic complication, for a complicated intramural pseudocyst involving the lesser curvature of the stomach 5, 6

Imaging Characteristics

• CT attenuation values of 59 Hounsfield units indicate high protein or blood content within the pseudocyst, according to the Journal of the National Comprehensive Cancer Network 1, 2
• MRI would typically show heterogeneous hyperintensity on both T1 and T2-weighted sequences in hemorrhagic cysts, as reported by the Journal of Hepatology 3, 4
• The presence of previous hemorrhage without current active bleeding is consistent with a sequela of intrinsic hemorrhage, as described by the Journal of Hepatology 3, 4

Coding Considerations

• The pseudocyst is located in the gastric wall (intramural) and involves the lesser curvature of the stomach, with evidence of previous hemorrhage (59 HU), as noted by the Journal of the American College of Radiology 6, 4
• The absence of active bleeding is an important distinction for both coding and clinical management, with the American College of Radiology recommending the use of code K86.3 with an additional code for the hemorrhagic complication 2