Isolated massive pleural effusion caused by pancreatico-pleural fistula

Background: Massive pleural effusions are uncommon but well-documented comp lications of chronic pancreatitis, usually caused by the development of a p ancreaticopleural fistula. The mechanism of the fistula formation is though t to be rupture of the pancreatic duct or pseudocyst. Material and methods: In the past 7 years we have treated 5 patients with m assive pleural effusion of pancreatic origin in the Surgical Department of Semmelweis University Medical School. 4 patients were males; the average ag e was 52 years (range: 46-59 years). Results: All 5 patients had a history of alcohol abuse and were admitted to the pulmonary department because of respiratory distress. Other symptoms s uch as abdominal pain, chest pain, or weight loss were not always present. The diagnosis was confirmed by a markedly elevated amylase level in the asp irated pleural fluid. Abdominal ultrasound, CT scan, and ERCP examinations were carried out in order to determine the cause of the pancreaticopleural fistula. Conservative (nonsurgical) treatment was effective within 3 weeks in only one case. The other 4 patients required surgical management, In 3 c ases distal pancreatic resection with splenectomy and cholecystectomy was d one. In one case cystojejunostomy was performed. All 5 patients have been c ured with complete resolution of their pleural effusions. Conclusions: Patients with large pleural effusions may have underlying panc reatitis with a pancreaticopleural fistula. It is important to establish th is diagnosis because treatment may require operative interventions.