Bilateral Pleural Fluid Caused by a Pancreaticopleural Fistula Requiring Surgical Treatment

• Published in: Internal Medicine Vol. 51; no. 18; pp. 2655 - 2661
• Main Authors: Sonoda, Shiro, Taniguchi, Miki, Sato, Tomohide, Yamasaki, Motohisa, Enjoji, Megumu, Mae, Sunao, Irie, Tetsuya, Ina, Hiroyasu, Sumi, Yuki, Inase, Naohiko, Kobayashi, Takayoshi
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Society of Internal Medicine 01.01.2012
• Subjects: amylase; Amylases - metabolism; Cholangiopancreatography, Endoscopic Retrograde; Humans; Male; Middle Aged; Pancreatectomy; Pancreatic Ducts - pathology; Pancreatic Fistula - complications; Pancreatic Fistula - pathology; Pancreatic Fistula - surgery; pancreaticopleural fistula; pancreatitis; Pleural Cavity - pathology; pleural effusion; Pleural Effusion - diagnosis; Pleural Effusion - etiology; Pleural Effusion - metabolism; Treatment Outcome
• ISSN: 0918-2918; 1349-7235
• DOI: 10.2169/internalmedicine.51.7859

A 53-year-old man developed bilateral pleural effusion with respiratory failure. The amylase level in the pleural effusion was elevated. He had neither abdominal symptoms nor abdominal physical findings. Abdominal computed tomography (CT) also showed no abnormalities. Magnetic resonance cholangiopancreatography (MRCP) was non-diagnostic, but endoscopic retrograde cholangiopancreatography (ERCP) and subsequent CT showed a fistula connecting the pancreatic duct with the right pleural cavity. The pleural effusion was refractory to drug therapy, leading to the need for surgical intervention. The pathological findings revealed chronic pancreatitis without pseudocysts. The elevated pancreatic amylase in the pleural effusion offered an important clue to the correct diagnosis.