scholarly journals Ruptured mediastinal pseudocyst with pancreaticopleural fistula formation in a 15-year-old boy presenting with white-out hemithorax: A case report

2022 ◽  
pp. 547-549
Author(s):  
Mohd Monis ◽  
Md Khalaf Saba ◽  
Syed M Danish Qaseem ◽  
Nadeem Arshad
Keyword(s):  
Pleural Fluid ◽  
Rare Case ◽  
Rare Complication ◽  
Necrotizing Pancreatitis ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Fistula Formation ◽  
Direct Visualization ◽  
Pleural Effusions ◽  
Fluid Analysis ◽  
Progressive Dyspnea

Pancreaticopleural fistula (PPF) is a rare complication of chronic pancreatitis described more commonly in adults with alcoholic and necrotizing pancreatitis. We report a rare case of ruptured mediastinal pseudocyst with the formation of PPF in a 15-year-old boy who presented with progressive dyspnea and large left-sided pleural effusion that recurred despite repeated drainage. On the basis of imaging findings and pleural fluid analysis, the diagnosis of PPF with ruptured mediastinal pseudocyst was made. The diagnosis of PPF should be considered in patients with non-resolving large left-sided pleural effusions. The diagnosis can be confirmed either by significantly raised amylase levels in pleural fluid or direct visualization of the fistula on Computed tomography/magnetic resonance cholangiopancreatography.

scholarly journals Pancreaticopleural Fistula: A Cause of Recurrent Pleural Effusions in Chronic Pancreatitis

2021 ◽  
Author(s):  
Ayah Megahed ◽  
Rahul Hegde ◽  
Pranav Sharma ◽  
Rahmat Ali ◽  
Anas Bamashmos
Keyword(s):  
Chronic Pancreatitis ◽  
Pancreatic Duct ◽  
Pleural Fluid ◽  
Rare Complication ◽  
Delayed Diagnosis ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Pleural Effusions ◽  
Diagnostic Challenge ◽  
Abdominal Symptoms ◽  
Pancreatic Duct Stenting

AbstractPancreaticopleural fistula is a rare complication of chronic pancreatitis caused by disruption of the pancreatic duct and fistulous communication with the pleural cavity. It usually presents with respiratory symptoms from recurrent large volume pleural effusions. Paucity of abdominal symptoms makes it a diagnostic challenge, leading often to delayed diagnosis. Marked elevation of pleural fluid amylase, which is not a commonly performed test, is a sensitive marker in its detection. Imaging with magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography can help delineate the fistula. In this report, we present the clinical features, imaging, and management of a 59-year-old male patient with pancreaticopleural fistula, wherein the diagnosis was suspected only after repeated pleural fluid drainages were performed for re-accumulating pleural effusions and it was eventually successfully treated with pancreatic duct stenting. We review the literature with regards to the incidence, presentation, diagnosis, and management of this rare entity.

scholarly journals Pancreatico‑pleural Fistula: Case Series

2018 ◽  
Vol 09 (01) ◽  
pp. 026-031 ◽  
Author(s):  
Manoj Munirathinam ◽  
Pugazhendhi Thangavelu ◽  
Ratnakar Kini
Keyword(s):  
Magnetic Resonance ◽  
Pleural Effusion ◽  
Pleural Fluid ◽  
Case Series ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Fluid Analysis ◽  
High Index Of Suspicion ◽  
Enhanced Computed Tomography ◽  
Acute And Chronic Pancreatitis ◽  
Pancreatic Pathology

ABSTRACTPancreatico‑pleural fistula is a rare but serious complication of acute and chronic pancreatitis. The pleural effusion caused by pancreatico‑pleural fistula is usually massive and recurrent. It is predominately left‑sided but right‑sided and bilateral effusion does occur. We report four cases of pancreatico‑pleural fistula admitted to our hospital. Their clinical presentation and management aspects are discussed. Two patients were managed by pancreatic endotherapy and two patients were managed conservatively. All four patients improved symptomatically and were discharged and are on regular follow‑up. Most of these patients would be evaluated for their breathlessness and pleural effusion delaying the diagnosis of pancreatic pathology and management. Hence, earlier recognition and prompt treatment would help the patients to recover from their illnesses. Pancreatic pleural fistula diagnosis requires a high index of suspicion in patients presenting with chest symptoms or pleural effusion. Extremely high pleural fluid amylase levels are usual but not universally present. A chest X‑ray, pleural fluid analysis, and abdominal imaging (magnetic resonance cholangiopancreatography/magnetic resonance imaging abdomen more useful than contrast‑enhanced computed tomography abdomen) would clinch the diagnosis. Endoscopic retrograde cholangiopancreatography with stent or sphincterotomy should be considered when pancreatic duct (PD) reveals a stricture or when medical management fails in patients with dilated or irregular PD. Surgical intervention may be indicated in patients with complete disruption of PD or multiple strictures.

scholarly journals A hematologic condition expressed as a lung disease

F1000Research ◽  
2012 ◽  
Vol 1 ◽  
pp. 28 ◽  
Author(s):  
Mónica Egozcue-Dionisi ◽  
José Nieves-Nieves ◽  
Ricardo Fernández-Gonzalez ◽  
Rosángela Fernández-Medero ◽  
Raúl Reyes-Sosa ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Pleural Effusion ◽  
Plasma Cells ◽  
Rare Complication ◽  
Disease Stage ◽  
Fluid Analysis ◽  
Progressive Dyspnea ◽  
Breath Sounds ◽  
The Right ◽  
Pleural Involvement

Pleural involvement secondary to Multiple Myeloma is considered a very rare complication. According to the literature only 1% of these patients develop a myelomatous pleural effusion. We present a case of a 39 year old man with multiple myeloma diagnosed six years prior to our evaluation, which developed progressive dyspnea, dry cough and right pleuritic chest pain two weeks prior to admission. On physical examination the patient had decreased breath sounds over the right posterior hemithorax accompanied by dullness to percussion. The chest radiogram was consistent with a right sided pleural effusion. Pleural fluid analysis revealed the presence of abundant abnormal plasma cells. The patient died four weeks after hospitalization. The presence of myelomatous pleural effusion is considered to be a poor prognostic finding, no matter at what disease stage it develops. So far no definite treatment has been shown to improve survival.

scholarly journals Application of Computed Tomography (CT) Attenuation Values in Diagnosis of Transudate and Exudate in Patients with Pleural Effusion

2018 ◽  
Vol 11 (02) ◽  
pp. 19-25
Author(s):  
Keshab Sharma ◽  
PS Lamichhane ◽  
BK Sharma
Keyword(s):  
Computed Tomography ◽  
Pleural Effusion ◽  
Ct Scan ◽  
Pleural Fluid ◽  
Pleural Effusions ◽  
Hounsfield Units ◽  
Fluid Analysis ◽  
Ct Attenuation ◽  
The Mean ◽  
Attenuation Values

Background: Pleural effusion is the pathologic accumulation of fluid in the pleural space. The fluid analysis yields important diagnostic information, and in certain cases, fluid analysis alone is enough for diagnosis. Analysis of pleural fluid by thoracentesis with imaging guidance helps to determine the cause of pleural effusion. The purpose of this study was to assess the accuracy of computed tomography (CT) in characterizing pleural fluid based on attenuation values and CT appearance. Materials and Methods: This prospective study included 100 patients admitted to Gandaki Medical College and Teaching Hospital, Pokhara, Nepal between January 1, 2017 and February 28, 2018. Patients who were diagnosed with pleural effusion and had a chest CT followed by diagnostic thoracentesis within 48 hours were included in the study. Effusions were classified as exudates or transudates using laboratory biochemistry markers on the basis of Light’s criteria. The mean attenuation values of the pleural effusions were measured in Hounsfield units in all patients using a region of interest with the greatest quantity of fluid. Each CT scan was also reviewed for the presence of additional pleural features. Results: According to Light’s criteria, 26 of 100 patients with pleural effusions had transudates, and the remaining patients had exudates. The mean attenuation of the exudates (16.5 ±1.7 HU; 95% CI, range, -33.4 – 44 HU) was significantly higher than the mean attenuation of the transudates (11.6 ±0.57 HU; 95% CI, range, 5 - 16 HU), (P = 0.0001). None of the additional CT features accurately differentiated exudates from transudates (P = 0.70). Fluid loculation was found in 35.13% of exudates and in 19.23% of transudates. Pleural thickening was found in 29.7% of exudates and in 15.3% of transudates. Pleural nodule was found in 10.8% of exudates which all were related to the malignancy. Conclusion: CT attenuation values may be useful in differentiating exudates from transudates. Exudates had significantly higher Hounsfield units in CT scan. Additional signs, such as fluid loculation, pleural thickness, and pleural nodules were more commonly found in patients with exudative effusions and could be considered and may provide further information for the differentiation.

scholarly journals The Use of Thoracic Ultrasound to Predict Transudative and Exudative Pleural Effusion

POCUS Journal ◽  
2021 ◽  
Vol 6 (2) ◽  
pp. 97-102
Author(s):  
Peter T. Evans ◽  
Robert S. Zhang ◽  
Yulei Cao ◽  
Sean Breslin ◽  
Nova Panebianco ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Pleural Fluid ◽  
Patient Characteristics ◽  
Pleural Effusions ◽  
Predictive Values ◽  
Fluid Analysis ◽  
Imaging Characteristics ◽  
Characteristics Of Image ◽  
Reliable Differentiation ◽  
Exudative Pleural Effusion

Objectives: Pleural effusion is a common reason for hospital admission with thoracentesis often required to diagnose an underlying cause. This study aimed to determine if the imaging characteristics of TUS effectively differentiates between transudative and exudative pleural fluid. Methods: Patients undergoing TUS with pleural fluid analysis were retrospectively identified at a single center between July 2016 and March 2018. TUS images were interpreted and characterized by established criteria. We determined diagnostic performance characteristics of image criteria to distinguish transudative from exudative pleural effusions.  Results: 166 patients underwent thoracentesis for fluid analysis of which 48% had a known malignancy. 74% of the pleural effusions were characterized as exudative by Light’s Criteria. TUS demonstrated anechoic effusions in 118 (71%) of samples. The presences of septations on TUS was highly specific in for exudative effusions (95.2%) with high positive predictive values (89.5%) and likelihood ratio (2.85). No TUS characteristics, even when adjusting for patient characteristics such as heart failure or malignancy, were sensitive for exudative effusions.  Conclusions: Among our cohort, anechoic images did not allow reliable differentiation between transudative and exudative fluid. Presence of complex septated or complex homogenous appearance was high specific and predictive of exudative fluid.

scholarly journals Umbilical Venous Catheterization in a Neonate Causing Pleural Effusion

2021 ◽  
Vol 36 (2) ◽  
pp. e242-e242
Author(s):  
Suresh Kotinatot ◽  
Devendra Jadhav ◽  
Ahmed Elajab ◽  
Munira Al Maazmi
Keyword(s):  
Pleural Effusion ◽  
Parenteral Nutrition ◽  
Respiratory Distress ◽  
Total Parenteral Nutrition ◽  
Rare Case ◽  
Rare Complication ◽  
Venous Catheter ◽  
X Ray ◽  
Fluid Analysis ◽  
Venous Catheterization

Pleural effusion is an extremely rare complication in neonates after umbilical venous catheterization that can present with respiratory distress, a neonatal emergency. It needs timely intervention to reduce respiratory distress. We report an interesting and rare case where a term newborn developed right-sided pleural effusion after umbilical venous catheter (UVC) insertion and starting on total parenteral nutrition (TPN). Pleural effusion was confirmed by X-ray and ultrasound and treated with intercostal drainage. The aspirated fluid was TPN, as evidenced by pleural fluid analysis. Pleural effusion resolved after removing the UVC.

Pleural Effusion

2015 ◽  
Author(s):  
Rafael S. Andrade ◽  
Eitan Podgaetz
Keyword(s):  
Pleural Effusion ◽  
Pleural Fluid ◽  
Tube Placement ◽  
Pleural Effusions ◽  
Computed Tomographic ◽  
Fluid Analysis ◽  
Management Algorithm ◽  
Practical Guidelines ◽  
Basic Facts ◽  
Subcutaneous Tunneling

Pleural effusions can occur in a wide variety of clinical situations. The most important test for the initial diagnosis and evaluation of a pleural effusion is the chest radiograph. Further investigation, such as imaging, pleural fluid analysis, pleural biopsy, and thoracoscopy, may be required to determine the etiology of the pleural effusion. This review covers the clinical evaluation, investigative studies, and management of pleural effusion, as well as basic facts of the pleura. An algorithm shows the approach to the patient with a pleural effusion. Figures show chest radiographs of patients with pleural effusion; six computed tomographic scans (showing right-side empyema showing a loculated effusion; a free-flowing, sickle-shaped, right-side effusion; parapneumonic effusion [PPE] at diagnosis, after initial chest tube placement, and after fibrinolytics; and left-side chylothorax secondary to lymphoma); an algorithm to manage known malignant pleural effusions; and a photograph of a PleurX catheter after placement and subcutaneous tunneling. Tables list the pathophysiologic mechanisms of pleural effusion, differential diagnosis for pleural effusions, relationship between pleural fluid appearance and causes, pleural fluid tests for causative assessment, practical guidelines for definitive management of malignant pleural effusion, and categorization of PPE by risk of poor outcome. Techniques for bedside thoracentesis and tube thoracostomy as well as for bedside fibrinolytic use are also presented. This review contains 1 management algorithm, 8 figures, 6 tables, and 92 references.

scholarly journals Mirizzi syndrome complicated by common hepatic duct fistula and left hepatic atrophy: a case report

2018 ◽  
Vol 46 (11) ◽  
pp. 4806-4812 ◽  
Author(s):  
Jiang Zhou ◽  
Rui Xiao ◽  
Jing-rui Yang ◽  
Lu Wang ◽  
Jia-xing Wang ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Hepatic Duct ◽  
Rare Complication ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Mirizzi Syndrome ◽  
Fistula Formation ◽  
Common Hepatic Duct ◽  
Asian Woman ◽  
Calot’S Triangle ◽  
Hepatic Atrophy

Background Mirizzi syndrome is a rare complication of chronic cholecystitis, usually caused by gallstones impacted in the cystic duct or the neck of the gallbladder. Mirizzi syndrome results in compression of the hepatic duct or fistula formation between the gallbladder and common bile duct (or hepatic duct, right hepatic duct, or even mutative right posterior hepatic duct). Clinical features include abdominal pain, fever, and obstructive jaundice. Severe inflammation and adhesion at Calot’s triangle are potentially very dangerous for patients with Mirizzi syndrome undergoing cholecystectomy. Case presentation: We report the case of a 68-year-old Asian woman who presented with abdominal pain and jaundice. She had a medical history of gallstones, but no fever. Magnetic resonance cholangiopancreatography revealed cholecystitis, cholelithiasis, common hepatic duct stones, and ascites. Findings at surgery included a porcelainized, atrophic gallbladder that was full of gallstones, fistula formation between the gallbladder and common hepatic duct, and left hepatic atrophy. The prominent feature was the left hepatic atrophy, but stones were not visible pre-operatively in the left liver by radiologic examination. Conclusions This patient exhibited what can be considered a special type II of Mirizzi syndrome with a fistula of the common hepatic duct as well as left hepatic atrophy.

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