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05 July 2017 : Case report  USA

Recurrent Pleural Effusion Secondary to a Pancreatic-Pleural Fistula Treated Endoscopically

Unusual clinical course, Challenging differential diagnosis, Educational Purpose (only if useful for a systematic review or synthesis)

Marco Antonio Bustamante Bernal1ABCDEF*, Jose Lisandro Gonzalez Martinez1AB, Arleen Ortiz2BD, Marc J. Zuckerman2ABCDEFG

DOI: 10.12659/AJCR.903925

Am J Case Rep 2017; 18:750-753

Abstract

BACKGROUND: Pancreatic-pleural fistula (PPF) is an uncommon complication of pancreatitis. Pleural effusions secondary to PPF are caused by fistulization of pancreatic secretions to the thorax derived from the rupture or leakage of a pseudocyst.

CASE REPORT: We describe the case of a 44-year-old male with recurrent right-sided pleural effusions and alcoholic pancreatitis who presented with epigastric pain and shortness of breath. Pleural fluid analysis revealed an amylase of 7002 U/lt. MRCP showed segmental narrowing and stricture of the proximal main pancreatic duct and an area of walled-off necrosis. The fistula was managed endoscopically with ERCP and placement of a plastic stent into the pancreatic duct. The pleural effusion resolved and subsequent examinations showed no evidence of recurrence.

CONCLUSIONS: The diagnosis of PPF is challenging. Endoscopic treatment of PPF can be a safe and effective approach.

Keywords: Pancreatic Fistula, Pancreatitis, Pleural Effusion

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923