Bilateral Pleural Fluid Caused by a Pancreaticopleural Fistula Requiring Surgical Treatment

Shiro Sonoda; Miki Taniguchi; Tomohide Sato; Motohisa Yamasaki; Megumu Enjoji; Sunao Mae; Tetsuya Irie; Hiroyasu Ina; Yuki Sumi; Naohiko Inase; Takayoshi Kobayashi

doi:10.2169/internalmedicine.51.7859

CASE REPORTS

Bilateral Pleural Fluid Caused by a Pancreaticopleural Fistula Requiring Surgical Treatment

Shiro Sonoda, Miki Taniguchi, Tomohide Sato, Motohisa Yamasaki, Megumu Enjoji, Sunao Mae, Tetsuya Irie, Hiroyasu Ina, Yuki Sumi, Naohiko Inase, Takayoshi Kobayashi

Author information

Shiro Sonoda
Internal Medicine, Nakano General Hospital, Japan
Department of Integrated Pulmonology, Tokyo Medical and Dental University, Japan
Miki Taniguchi
Internal Medicine, Nakano General Hospital, Japan
Tomohide Sato
Internal Medicine, Nakano General Hospital, Japan
Motohisa Yamasaki
Internal Medicine, Nakano General Hospital, Japan
Megumu Enjoji
Surgery, Nakano General Hospital, Japan
Sunao Mae
Internal Medicine, Nakano General Hospital, Japan
Tetsuya Irie
Internal Medicine, Nakano General Hospital, Japan
Hiroyasu Ina
Radiology, Nakano General Hospital, Japan
Yuki Sumi
Department of Integrated Pulmonology, Tokyo Medical and Dental University, Japan
Naohiko Inase
Department of Integrated Pulmonology, Tokyo Medical and Dental University, Japan
Takayoshi Kobayashi
Internal Medicine, Nakano General Hospital, Japan

Keywords: pancreaticopleural fistula, pleural effusion, pancreatitis, amylase

JOURNAL OPEN ACCESS

2012 Volume 51 Issue 18 Pages 2655-2661

DOI https://doi.org/10.2169/internalmedicine.51.7859

Details

Abstract

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.

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