Primary presentation of chronic calcific pancreatitis with massive unilateral pleural effusion

Abstract

SUMMARYWe described a 45-year-old previously healthy man presenting with progressively worsening breathlessness for 10 days. Physical examination was suggestive of a left-sided pleural effusion. A chest X-ray was confirmatory. Analysis of aspirated fluid showed a lymphocytic exudate with grossly elevated amylase and lipase levels. CT revealed chronic calcific pancreatitis as the underlying cause of effusion. Retrospective questioning failed to identify classical symptoms of chronic pancreatitis including abdominal pain and steatorrhoea. The patient was managed with intercostal drainage and supportive care. Although unusual, chronic pancreatitis should be kept as a differential diagnosis in patients with unilateral exudative pleural effusion. Elevated fluid levels of amylase and lipase are useful clues to this uncommon diagnosis. BACKGROUND

Chronic pancreatitis with Bochdalek hernia causing right-sided pleural effusion in a previously asymptomatic adult

“… 9 A high amylase level in diagnostic thoracentesis should lead one to think more about chronic pancreatitis as a possible aetiology of a patient’s pleural effusion. 10 It is thought that the pancreatic digestive juices can travel posteriorly into the retroperitoneum and communicate through the fistula into the pleural space to form a pleural effusion rich in amylase. 11 12 ERCP and MRCP are methods that can be used in order to better elucidate the anatomy of the pancreatic ducts in patients and possibly stent any areas that might have strictures.…”