Pleural Effusion with Pancreaticopleural Fistula

Tombroff, M; Loicq, A; Koster, De; Engleholm, L; Jp, Govaerts

doi:10.1136/bmj.1.5849.330

Cited by 54 publications

(31 citation statements)

References 3 publications

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“…pseudocyst, which will in turn rupture into the pleural cavity to form a PPF. (4)(5)(6)(7)(8)(9)(10) Direct transdiaphragmatic extension of the fistula into the mediastinum has also been reported. (9) The resulting pleural effusion from ascending fistulisation should be distinguished from the small, self-limiting left-sided effusion that occurs in 3%-17% of patients with acute pancreatitis.…”

Section: Case Illustr Ationmentioning

confidence: 99%

“…(11,15) In the past, imaging of PPF was attempted via intrapleural injection of contrast media. (7) At present, although CT of the thorax and abdomen has been successful in identifying PPF, its overall ability to provide accurate delineation of the fistula is disputable and its sensitivity is poor compared to the other modalities. Nevertheless, CT is still useful in demonstrating pancreatic parenchymal atrophy, calcification, duct dilatation and pseudocysts.…”

Section: Diagnosis and Investig Ationsmentioning

confidence: 99%

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Diagnosis and management of pancreaticopleural fistula

Tay

Chang²

2013

SMedJ

100

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Pancreaticopleural fistula is a rare diagnosis requiring a high index of clinical suspicion due to the predominant manifestation of thoracic symptoms. The current literature suggests that confirmation of elevated pleural fluid amylase is the most important diagnostic test. Magnetic resonance cholangiopancreatography is the recommended imaging modality to visualise the fistula, as it is superior to both computed tomography and endoscopic retrograde cholangiopancreatography (ERCP) in delineating the tract within the pancreatic region. It is also less invasive than ERCP. While a trial of medical regimen has traditionally been the first-line treatment, failure would result in higher rates of complications. Hence, it is suggested that management strategies be planned based on pancreatic ductal imaging, with patients having poor chances of spontaneous closure undergoing either endoscopic or surgical intervention. We also briefly describe a case of pancreaticopleural fistula in a patient who was treated using a modified Puestow procedure after failed endoscopic treatment.

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Section: Case Illustr Ationmentioning

confidence: 99%

Section: Diagnosis and Investig Ationsmentioning

confidence: 99%

Diagnosis and management of pancreaticopleural fistula

Tay

Chang²

2013

SMedJ

100

View full text Add to dashboard Cite

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“…The ruptured cyst passes either through the aortic or oesophageal hiatus or directly through diaphragm into pleural cavity leading to pancreaticopleural fistula (Tombroff et al, 1973). The enzyme-rich pleural fluid is due to disruption of the dorsal pancreatic ductal system (Traverso & Kozarek, 1999).Typically, the patients are middle-aged males(40-50 years) with chronic pancreatitis related mainly to alcohol abuse.…”

Section: Discussionmentioning

confidence: 99%