Thoracic complications of pancreatitis

Kumar, P. S.; Gupta, Pankaj; Rana, Satya Vati

doi:10.1002/jgh3.12099

Cited by 35 publications

(63 citation statements)

References 84 publications

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“…Previous studies [ 17 – 19 ] have shown that ARDS is one of the early serious complications of SAP and can increase the mortality of SAP patients. The incidence of ARDS in SAP varies from 25.44% to 59.21% in previous studies, [ 20 , 21 ] and the incidence of ARDS in SAP patients in our study is 30.60%. Therefore, it is extremely important to clarify the risk factors of SAP patients with ARDS and to intervene early for the prevention and treatment of ARDS in SAP patients.…”

Section: Discussionsupporting

confidence: 48%

The risk factors for acute respiratory distress syndrome in patients with severe acute pancreatitis

Zhang¹,

Zhang²,

Kuang³

et al. 2021

Medicine

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Acute respiratory distress syndrome (ARDS) is very common in patients with severe acute pancreatitis (SAP), the early interventions are essential to the prognosis of SAP patients. We aimed to evaluate the risk factors for ARDS in SAP patients, to provide insights into the management of SAP. SAP patients treated in our hospital from June 1, 2018 to May 31, 2020 were included. The characteristics and lab test results were collected and compared, and we conducted the logistic regression analyses were conducted to identify the potential risk factors for ARDS in patients with SAP. A total of 281 SAP patients were included finally, the incidence of ARDS in patients with SAP was 30.60%. There were significant differences on the respiratory rate, heart rate, APACHE II and Ranson score between 2 groups (all P < .05). And there were significant differences on the polymorphonuclear, procalcitonin, C-reactive protein, serum creatinine, albumin and PO2/FiO2 between 2 groups (all P < .05), and no significant differences on the K+, Na+, Ca+, white blood cell, neutrophils, urine and blood amylase, trypsin, lipase, alanine aminotransferase, aspartate aminotransferase, total bilirubin, triglyceride, total cholesterol, total bilirubin, fasting blood glucose, and pH were found (all P > .05). Respiratory rate >30/min (odds ratio [OR]: 2.405, 95% confidence interval[CI]: 1.163–4.642), APACHE II score >11 (OR: 1.639, 95% CI: 1.078–2.454), Ranson score >5 (OR: 1.473, 95% CI: 1.145–2.359), polymorphonuclear >14 × 109/L (OR: 1.316, 95% CI: 1.073–2.328), C-reactive protein >150 mg/L (OR: 1.127, 95% CI: 1.002–1.534), albumin ≤30 g/L (OR: 1.113, 95% CI: 1.005–1.489) were the independent risk factors for ARDS in patients with SAP (all P < .05). The incidence of ARDS in SAP patients is relatively high, and it is necessary to carry out targeted early prevention and treatment for the above risk factors.

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Section: Discussionsupporting

confidence: 48%

The risk factors for acute respiratory distress syndrome in patients with severe acute pancreatitis

Zhang¹,

Zhang²,

Kuang³

et al. 2021

Medicine

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“…In accordance with the revised Atlanta classification, diagnosis of AP required at least 2 of the following 3 diagnostic features: persistent abdominal pain, serum lipase or amylase activity at least 3 times the upper limit of the normal range, and characteristic findings on abdominal imaging [ 3 ]. Pleural effusion was diagnosed as blunting of the costophrenic or cardiophrenic angle confirmed by computed tomography (CT) [ 12 ]. Alcoholism was defined as ingestion of >30 g/day of alcohol in men and >20 g/day in women.…”

Section: Methodsmentioning

confidence: 99%

“…Imaging is a requirement for AP diagnosis, and with it, chest lesions including pleural effusion, pneumonia, and atelectasis can be detected in the early stages of the illness. Pleural effusion is found in up to 50% patients with AP [ 12 , 13 ] and is an independent predictor of AP severity [ 14 ]. In addition, pleural effusion can reduce cardiac output and produce hypoxemia, which in turn can lead to renal injury, manifested as a decreased glomerular filtration rate (GFR) and renal tubular epithelial cell damage [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Pleural Effusion Is Associated with Severe Renal Dysfunction in Patients with Acute Pancreatitis

Zeng¹,

Jiang

Wu³

et al. 2021

Med Sci Monit

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Background Renal dysfunction is a leading cause of death in patients with acute pancreatitis (AP) and often occurs later than respiratory complications. Whether respiratory complications can predict renal impairment remains unclear. The aim of this study was to investigate the association between pleural effusion and renal dysfunction in AP. Material/Methods Medical records were reviewed from individuals who were hospitalized with AP from January 1, 2015 to December 31, 2019. The patients were divided into 2 groups, based on the presence or absence of pleural effusion on admission. Disease severity, renal function parameters, and outcomes were compared between the 2 groups. Results A total of 222 patients were enrolled, 25 of whom had pleural effusion on admission and 197 who did not. Patients with AP who had pleural effusion had more serious illness (higher incidences of pancreatic inflammation, pancreatic fluid collection, and moderate-to-severe AP; worse Bedside Index for Severity in Acute Pancreatitis score; and a higher modified computed tomography severity index [all P <0.05]) plus worse outcomes (higher incidences of ventilation and vasopressor use [both P <0.05]). Moreover, patients with pleural effusion had a higher level of blood urea nitrogen and lower estimated glomerular filtration rate (both P <0.05). After adjustment for potential confounders, pleural effusion was a risk factor for renal failure in patients with AP (odds ratio 6.32, 95% confidence interval 1.08–36.78, P =0.040). Conclusions Pleural effusion is associated with severe renal dysfunction in AP. Therefore, efforts should be made to improve early recognition and timely treatment of renal failure by closely monitoring renal function in patients with AP and pleural effusion on admission.

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“…Thoracic extension of pancreatic pseudocysts (TPP) is a rare entity with as few as 75 cases reported. However, it is worth noting the severe implications with 29–39% of deaths from pancreatitis attributable to pulmonary complications [ 2 ]. If not recognized TPP may have disastrous complications, including: pneumonia, empyema, tamponade, pseudoaneurysm, oesophageal perforation, massive haemoptysis and Bronchopleural fistula [ 1 , 6 , 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…Dissecting through tissue planes PP may track into the thorax most commonly via the Oesophageal or Aortic Hiatuses, and rarely through Morgagni’s Foramen or Traumatic tracts. The literature contains only limited management suggestions, without standardized guidelines [ 2 , 3 ]. Herein we discuss our approach to a massive pancreatic pseudocyst extending into the left Hemithorax.…”

Section: Introductionmentioning

confidence: 99%

Pseudocyst of the pancreas masquerading as spontaneous pneumomediastinum

Brookes

Mathew

Munasinghe

et al. 2019

Journal of Surgical Case Reports

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Pseudocyst of the pancreas extending into the thorax represents a rare but potentially catastrophic diagnosis. It can be difficult to both diagnose and manage, with only limited management suggestions within the literature. While pleural effusion is a common complication of pancreatitis, transthoracic extension of a pseudocyst is a rare phenomenon. Herein we discuss a patient with a difficult to recognize extension of pancreatic pseudocyst into the left hemithorax, with unique imaging findings. He had good response to trans-gastric and percutaneous drainage and ultimately proceeded to thoracotomy and decortication. Around this case, the options for investigation and management are discussed.

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Thoracic complications of pancreatitis

Cited by 35 publications

References 84 publications

The risk factors for acute respiratory distress syndrome in patients with severe acute pancreatitis

The risk factors for acute respiratory distress syndrome in patients with severe acute pancreatitis

Pleural Effusion Is Associated with Severe Renal Dysfunction in Patients with Acute Pancreatitis

Pseudocyst of the pancreas masquerading as spontaneous pneumomediastinum

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