A case of chronic pancreatitis complicated by massive pericardial and right pleural effusion

Abstract

A 42-year-old man was admitted complaining of dyspnea. Chest X-ray showed an increase in cardiac size, and echocardiography revealed a large volume of pericardial effusion. Pancreatic enzyme levels were elevated in both serum and pericardial effusion. Computed tomography and endoscopic retrograde pancreatography demonstrated a fistula connecting a pancreatic pseudocyst with the pericardium and the right pleural cavity. Massive pericardial and right pleural effusion is an extremely rare complication of chronic pancreatitis. In this case, computed tomography and endoscopic retrograde pancreatography were useful for diagnosing the fistula.

Massive right-sided hemorrhagic pleural effusion due to pancreatitis; a case report

“…Right-sided hemorrhagic pleural effusion as the sole manifestation of pancreatitis is rare [1-4,6,7] especially when it occurs in the non-alcoholic patient under the age of 20 [2,3]. The postulated pathogenic mechanisms for hemorrhagic effusions include transdiaphragmatic transfer of fluid via lymphatics, diaphragmatic perforation of pseudocyst and mediastinal extension [1].…”

“…The postulated pathogenic mechanisms for hemorrhagic effusions include transdiaphragmatic transfer of fluid via lymphatics, diaphragmatic perforation of pseudocyst and mediastinal extension [1]. Several studies demonstrated that a fistula connecting a pancreatic pseudocyst with pleural cavity was the mechanism of pleural effusion [4,7]. …”

Hemorrhagic pleural effusion due to pseudo-pancreatic cyst

“…Hemothorax rarely occurs as a sole manifestation of pancreatitis. [ 1 2 3 4 5 6 ] Most cases of hemorrhagic pleural effusion secondary to pancreatitis occur between the ages of 20 and 55, along with a risk factor of alcohol intake. [ 4 5 ] The postulated pathogenic mechanisms for hemorrhagic effusions include trans-diaphragmatic transfer of fluid via lymphatics, diaphragmatic perforation of the pseudocyst and mediastinal extension.…”

“…[ 1 ] Several studies demonstrated that a fistula connecting a pancreatic pseudocyst with pleural cavity was the plausible mechanism of pleural effusion. [ 6 7 ] A pancreaticopleural fistula is a rare complication of pancreatitis with reported incidence of only 0.4–4.5%. [ 8 ] The cyst fistulizing and bleeding massively to cause hemothorax have been very rarely reported.…”

Pancreaticopleural fistula imaged with magnetic resonance pancreatography

“…Although its demonstration is often difficult, endoscopic retrograde pancreatography (ERP) and CT have been employed for diagnostic purposes [1][2][3][4]. Recently, magnetic resonance pancreatography (MRP) has proven effective in a number of studies, with results generally equivalent to conventional ERP [5].…”