title: Bilateral pleural fluid caused by a pancreaticopleural fistula requiring surgical treatment.
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.
authors.affiliation: Internal Medicine, Nakano General Hospital, Japan.
authors.forename: Shiro
authors.initials: S
authors.lastname: Sonoda
authors.forename: Miki
authors.initials: M
authors.lastname: Taniguchi
authors.forename: Tomohide
authors.initials: T
authors.lastname: Sato
authors.forename: Motohisa
authors.initials: M
authors.lastname: Yamasaki
authors.forename: Megumu
authors.initials: M
authors.lastname: Enjoji
authors.forename: Sunao
authors.initials: S
authors.lastname: Mae
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Irie
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Ina
authors.forename: Yuki
authors.initials: Y
authors.lastname: Sumi
authors.forename: Naohiko
authors.initials: N
authors.lastname: Inase
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Kobayashi
mesh_terms: D000681:Amylases / Q000378:metabolism; D002760:Cholangiopancreatography, Endoscopic Retrograde; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy; D010183:Pancreatic Ducts / Q000473:pathology; D010185:Pancreatic Fistula / Q000150:complications* / Q000473:pathology / Q000601:surgery*; D035422:Pleural Cavity / Q000473:pathology; D010996:Pleural Effusion / Q000175:diagnosis* / Q000209:etiology* / Q000378:metabolism; D016896:Treatment Outcome
chemical_list: D000681:Amylases