In summary, when a cystic lesion of the pancreas is discovered with imaging, correlation with clinical history suggesting recent acute pancreatitis and consideration of demographic parameters remains important. If the lesion has characteristic findings of either main duct or combined IPMN, or mucinous cystic neoplasm, then resection is warranted, and the radiologist should evaluate the remainder of the study for staging purposes. If the cystic lesion is characteristic of a serous cystadenoma, is <4 cm, and the patient is asymptomatic, surgery need not be performed. If there are cyst-related symptoms or if an asymptomatic patient has a noncharacteristic cystic lesion that >3 cm or has nodules, resection is indicated. If those features are absent, the patient should undergo EUS to further evaluate tumor morphology and obtain FNA of the fluid. If none of the indications for resection is present, the patient may be followed up with imaging surveillance. If one of the features suggested in the guidelines becomes apparent during the surveillance period, consideration of resection is then warranted. The radiologist's role is pivotal in assessment of cystic lesions of the pancreas. Being able to provide information on pertinent morphologic features that trigger management change, correlate the imaging findings with history and prior studies, and guide imaging surveillance with appropriate recommendations is of paramount importance. © 2009 Elsevier Inc. All rights reserved.