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Michael Teklehaimanot Abera,1 Henok Dessalegn Damtew,1 Yodit Abraham Yaynishet,1 Amanuel Yegnanew Adela1– 3 1Department of Radiology, Addis Ababa University, Addis Ababa, Ethiopia; 2Department of Radiology, University of Gondar, Gondar, Ethiopia; 3Ethiopian Federal Police Commission Referral Hospital, Addis Ababa, EthiopiaCorrespondence: Michael Teklehaimanot Abera, Addis Ababa University, College of Health Sciences, Department of Radiology, P.O. Box 9080, Addis Ababa, Ethiopia, Email michael.thaimanot@aau.edu.et; th.miki8441@gmail.comAbstract: Pancreatic pseudocysts are benign lesions that typically originate within the pancreatic parenchyma, or peripancreatic tissue. They commonly occur following recurrent episodes of pancreatitis or trauma. In this article, we present a case of a giant pancreatic pseudocyst with unusual trans-spatial extensions and spontaneous size decrement in a 40-year-old male patient with a history of alcohol abuse. He presented with chronic epigastric pain, and a physical examination showed only mild abdominal tenderness. Initial computed tomography showed a giant (18.4cm in its largest axis) pancreatic pseudocyst with left subdiaphragmatic and gastrohepatic extensions and concurrent splenic cysts. On follow-up ultrasound, the pseudocyst showed a significant spontaneous size decrement to less than half of its initial size. The giant size and trans-spatial characteristics of the pseudocyst, along with a relatively benign symptomatology and subsequent spontaneous shrinkage, constitute unique aspects of this case.Keywords: pseudocyst, giant pseudocyst, pancreatitis, multiplanar CT, spontaneous drainage