scholarly journals Black pleural effusion: an unusual complication of pseudocyst pancreas

2021 ◽  
Vol 8 (7) ◽  
pp. 2238
Author(s):  
Spandana Jagannath ◽  
Ashok Kumar
Keyword(s):  
Pleural Effusion ◽  
Pancreatic Duct ◽  
Pancreatic Pseudocyst ◽  
Pleural Cavity ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Pancreatic Disease ◽  
Unusual Complication ◽  
Endoscopic Retrograde ◽  
Idiopathic Pancreatitis ◽  
Optimal Treatment Strategy

Pleural effusion following rupture of pancreatic pseudocyst into the pleural cavity resulting into pancreaticopleural fistula is an extremely uncommon complication of acute pancreatitis. Pancreaticopleural fistula also results from disruption of a major pancreatic duct usually due to an underlying pancreatic disease (chronic pancreatitis), trauma, or iatrogenic injury. Pleural effusion is predominantly left sided; however, right-sided and bilateral effusion occurs in 19% and 14% of patients respectively. The pleural effusate can be either serous, serosanguinous or black in colour. Analysis of pleural fluid for raised amylase will confirm the diagnosis and investigations like computed tomography (CT), endoscopic retrograde cholangiopancreatography (ECRP) or magnetic resonance cholangiopancreatography (MRCP) may establish the fistulous communication between the pancreas, pseudocyst and pleural cavity. The optimal treatment strategy has traditionally been medical management with thoracocentesis and/or tube thoracostomy and exocrine suppression with octreotide and ERCP stenting of the fistulous pancreatic duct. Surgery, in the current era, is considered in the event patient fails to respond to conservative management or the patient’s condition deteriorates. We report the case of a 24-years-old gentleman who was diagnosed with chronic idiopathic pancreatitis with pseudocyst who developed right sided black pleural effusion.

scholarly journals Pancreaticopleural Fistula: Revisited

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Norman Oneil Machado
Keyword(s):  
Pleural Effusion ◽  
Pleural Cavity ◽  
Rare Complication ◽  
Operative Therapy ◽  
Clinical Suspicion ◽  
Endoscopic Retrograde ◽  
Endoscopic Retrograde Cholangiopancreaticography ◽  
Acute And Chronic Pancreatitis ◽  
Optimal Treatment Strategy ◽  
Present View

Pancreaticopleural fistula is a rare complication of acute and chronic pancreatitis. This usually presents with chest symptoms due to pleural effusion, pleural pseudocyst, or mediastinal pseudocyst. Diagnosis requires a high index of clinical suspicion in patients who develop alcohol-induced pancreatitis and present with pleural effusion which is recurrent or persistent. Analysis of pleural fluid for raised amylase will confirm the diagnosis and investigations like CT. Endoscopic retrograde cholangiopancreaticography (ECRP) or magnetic resonance cholangiopancreaticography (MRCP) may establish the fistulous communication between the pancreas and pleural cavity. The optimal treatment strategy has traditionally been medical management with exocrine suppression with octreotide and ERCP stenting of the fistulous pancreatic duct. Operative therapy considered in the event patient fails to respond to conservative management. There is, however, a lack of clarity regarding the management, and the literature is reviewed here to assess the present view on its pathogenesis, investigations, and management.

scholarly journals Pancreaticopleural fistula: An insidious cause of pleural effusion –case report

2021 ◽  
Author(s):  
Fábio Murteira ◽  
Tiago Costa ◽  
Sara Barbosa Pinto ◽  
Elsa Francisco ◽  
Ana Catarina Gomes
Keyword(s):  
Computed Tomography ◽  
Acute Pancreatitis ◽  
Case Report ◽  
Pleural Effusion ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Pancreatic Amylase ◽  
Pleural Effusions ◽  
Primary Event ◽  
Endoscopic Retrograde ◽  
Left Chest

Pancreaticopleural fistulas (PPF) are a rare etiology of pleural effusions. We describe a case of a 61-year-old man, with left chest pain with six months of progression who presented with a large volume unilateral pleural effusion. A thoracentesis was performed, which showed a dark reddish fluid(exudate) and high content of pancreatic amylase. After that an abdominal computed tomography (CT)and magnetic resonance cholangiopancreatography (MRCP) was done, revealing fistulous pathways that originated in the pancreas. The patient was admitted for conservative and endoscopic treatment by Endoscopic Retrograde Cholangiopancreatography (ERCP) and a prosthesis was placed on a fistulous path. He was discharged without complications, with the resolution of the pleural effusion and fistula.The interest of this case lies in the rarity of the event and absence of symptoms of the probable primary event (acute pancreatitis). The possible iatrogenic association with several drugs of his usual medication makes it even more complex.

scholarly journals ERCP in Evaluating The Mode of Therapy in Pancreatic Pseudocyst

HPB Surgery ◽  
1988 ◽  
Vol 1 (1) ◽  
pp. 35-44 ◽  
Author(s):  
I. Nordback ◽  
O. Auvinen ◽  
I. Airo ◽  
J. Isolauri ◽  
O. Teerenhovi
Keyword(s):  
Pancreatic Duct ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Main Pancreatic Duct ◽  
Pancreatic Pseudocyst ◽  
Treatment Method ◽  
Internal Drainage ◽  
Endoscopic Retrograde ◽  
External Drainage ◽  
Computed Tomographic ◽  
Pancreatic Resections

Twenty patients with ultrasonographic or computed tomographic diagnosis of pancreatic pseudocyst were referred for endoscopic retrograde cholangiopancreatography (ERCP). Two of these were found at laparotomy not to have pseudocysts and were excluded. Pancreatography was successful in 15 out of 18 cases (83%) and cholangiography in 12 out of 18 cases (67%). Three types of pseudocysts were noticed according to the communication of the pseudocyst to the main pancreatic duct and the presence of pancreatic duct stensosis. Successful treatment included two spontaneous resolutions, two internal drainages and three left pancreatic resections. In the eight percutaneous external drainages four recurrences (50%) occurred, one after closure of temporary pancreatocutaneous fistula. All the recurrences occurred in Type III pseudocysts with communication of the pseudocysts to stenotic main pancreatic duct. In these cases internal drainage would have been the preferable treatment method. We believe that by ERCP one can identify pseudocysts not suitable for external drainage.

scholarly journals Pancreatic pleural effusion masquerading as right sided tubercular pleural effusion

2019 ◽  
Vol 89 (3) ◽  
Author(s):  
Gopal Chawla ◽  
Ram Niwas ◽  
Nishant Kumar Chauhan ◽  
Naveen Dutt ◽  
Taruna Yadav ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Magnetic Resonance ◽  
Pleural Effusion ◽  
Respiratory Distress ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Fistula Tract ◽  
Endoscopic Retrograde ◽  
Diagnostic Dilemma ◽  
Detailed History ◽  
High Index Of Suspicion

Pleural effusion is easily diagnosed often managed optimally with standard protocols. It at times, is a diagnostic dilemma as it comes with big list of differential diagnosis. Pleural effusion due to pancreaticopleural fistula (PPF) is a rare and on right side is even rarer. Detailed history along with high index of suspicion in required to diagnose PPF, which is confirmed by increased level of pleural fluid amylase and lipase along with magnetic resonance cholangiopancreatography (MRCP) or endoscopic retrograde cholangiopancreatography (ERCP) demonstrating fistula tract. Here we report the case of a young patient who presented with respiratory distress and was wrongly diagnosed as right sided tubercular effusion which later turned out to be pancreatic effusion. Management in our case was multi-disciplinary involving pulmonologist, gastroenterologist, radiologist and thoracic surgeon.

scholarly journals Endoscopic Treatment of an Idiopathic Pancreaticopleural Fistula

2021 ◽  
pp. 1-4
Author(s):  
João Correia ◽  
Rolando Pinho ◽  
Elsa Francisco ◽  
Luísa Proença ◽  
Carlos Fernandes ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Multidisciplinary Approach ◽  
Pancreatic Pseudocyst ◽  
Previous History ◽  
The Body ◽  
Surgical Approaches ◽  
Fistula Closure ◽  
Endoscopic Retrograde ◽  
History Of ◽  
Pancreatic Sphincterotomy

A 61-year-old man was diagnosed with an exudative pleural effusion with raised amylase and bilirubin levels. The patient had no previous history of acute pancreatitis or trauma and no clinical or radiological signs of chronic pancreatitis. On thoracoabdominal computed tomography, a pancreatic pseudocyst with a pancreaticopleural fistula was identified. Endoscopic retrograde cholangiopancreatography identified a ductal disruption site in the body of the pancreas. Pancreatic sphincterotomy and stent placement in the duct of Wirsung, combined with medical management, allowed fistula closure, pseudocyst reabsorption, and no relapse of the pleural effusion. The relevance of this case lies not only in its rarity but also as it highlights the importance of a multidisciplinary approach in such uncommon conditions. Optimal management of this condition is debatable due to the absence of prospective studies comparing medical, endoscopic, and surgical approaches.

scholarly journals Pancreaticopleural Fistula: A Review of Imaging Diagnosis and Early Endoscopic Intervention

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Ali Kord Valeshabad ◽  
Jennifer Acostamadiedo ◽  
Lekui Xiao ◽  
Winnie Mar ◽  
Karen L. Xie
Keyword(s):  
Pleural Cavity ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Therapeutic Endoscopy ◽  
Fistula Tract ◽  
Pleuritic Chest Pain ◽  
Endoscopic Retrograde ◽  
Left Pleural Cavity ◽  
History Of ◽  
Therapeutic Ercp ◽  
Safe Treatment Option

A 49-year-old male with history of chronic alcohol-induced pancreatitis presented with one month of worsening left pleuritic chest pain and shortness of breath. Chest radiograph demonstrated bilateral pleural effusions. Thoracentesis revealed increased amylase in the pleural fluid. Computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP) showed a fistula tract between the left pleural cavity and pancreas which was confirmed on endoscopic retrograde cholangiopancreatography (ERCP). Patient was treated with placement of a pancreatic stent with complete resolution of the fistula tract approximately in 9 weeks. A systematic literature search was performed on reported cases with pancreaticopleural fistula (PPF) who underwent early therapeutic endoscopy within the last 10 years. Imaging modalities, particularly CT and MRCP, play essential role in prompt preprocedural diagnosis of PPF. Early therapeutic ERCP is an effective and relatively safe treatment option for PPF, so invasive surgery may be avoided.

Pancreaticopleural fistula: an uncommon cause of amylase-rich pleural effusion

2020 ◽  
Vol 13 (8) ◽  
pp. e236232
Author(s):  
Valeri Kraskovsky ◽  
Brianne Mackenzie ◽  
Martin Jeffery Mador
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Chronic Pancreatitis ◽  
Pleural Effusion ◽  
Pancreatic Duct ◽  
Chronic Obstructive ◽  
Endoscopic Retrograde ◽  
Obstructive Pulmonary Disease ◽  
Rare Finding ◽  
Fluid Analysis ◽  
Exudative Pleural Effusion

Pancreaticopleural fistula (PPF) causing pleural effusion as a complication of chronic pancreatitis is a rare finding. We present this finding in a 52-year-old man with a medical history significant for alcohol abuse, acute on chronic pancreatitis and severe chronic obstructive pulmonary disease, who presented with worsening dyspnoea for 3 days. CT scan of the chest showed a new large right-sided pleural effusion. Thoracentesis was performed and pleural fluid analysis showed an amylase-rich, exudative pleural effusion. The effusion reaccumulated within 3 days necessitating repeat thoracentesis. Endoscopic retrograde chloangiopancreatography showed contrast leak through a single disruption in the dorsal pancreatic duct, suspicious for an underlying PPF. The patient underwent stenting of the pancreatic duct with subsequent resolution of right-sided pleural effusion.

scholarly journals Pancreatic pseudocyst, pancreatitis, and incomplete pancreas divisum in a child treated with endotherapy: a case report

2021 ◽  
Vol 49 (5) ◽  
pp. 030006052110143
Author(s):  
Jingxin Yan ◽  
Zheheng Zhang ◽  
Zhixin Wang ◽  
Wenhao Yu ◽  
Xiaolei Xu ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Pancreatic Pseudocyst ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Recurrent Pancreatitis ◽  
Endoscopic Retrograde ◽  
Lack Of Fusion ◽  
History Of ◽  
Pseudocyst Drainage ◽  
Medical Imagining

Pancreatic divisum (PD) is caused by the lack of fusion of the pancreatic duct during the embryonic period. Considering the incidence rate of PD, clinicians lack an understanding of the disease, which is usually asymptomatic. Some patients with PD may experience recurrent pancreatitis and progress to chronic pancreatitis. Recently, a 13-year-old boy presented with pancreatic pseudocyst, recurrent pancreatitis, and incomplete PD, and we report this patient’s clinical data regarding the diagnosis, medical imagining, and treatment. The patient had a history of recurrent pancreatitis and abdominal pain. Magnetic resonance cholangiopancreatography was chosen for diagnosis of PD, pancreatitis, and pancreatic pseudocyst, followed by endoscopic retrograde cholangiopancreatography, minor papillotomy, pancreatic pseudocyst drainage, and stent implantation. In the follow-up, the pseudocyst lesions were completely resolved, and no recurrent pancreatitis has been observed.

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