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 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 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 Pancreatic Mass or Cyst? Diagnostic Dilemma

2019 ◽  
Vol 37 (6) ◽  
pp. 521-524
Author(s):  
Jagpal Singh Klair ◽  
Rahman Nakshabendi ◽  
Maheen Rajput ◽  
Henning Gerke ◽  
Rami El-Abiad
Keyword(s):  
Magnetic Resonance ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Pancreatic Mass ◽  
Management Options ◽  
Diagnostic Dilemma ◽  
Recurrent Acute Pancreatitis ◽  
Single Episode ◽  
Minor Papilla ◽  
Diagnostic Modalities

A santorinicele is a rare anomaly defined as focal cystic dilation of the terminal portion of the dorsal pancreatic duct at the minor papilla. Importantly this anomaly has been suggested as a possible cause of relative stenosis of the minor papilla. This anomaly has been associated with pancreatic divisum and recurrent acute pancreatitis. Magnetic resonance imaging/magnetic resonance cholangiopancreatography and endoscopic ultrasound (EUS) are the main diagnostic modalities. Endoscopic minor papilla sphincterotomy has been shown to improve pain and quality of life in patients with this anomaly presenting with recurrent pancreatitis. We present a case of a single episode of pancreatitis who underwent EUS for evaluation of possible pancreatic mass leading to a diagnosis of santorinicele and complete pancreatic divisum. We attempt to describe this anomaly, diagnostic approach, and management options.

scholarly journals Calcific myonecrosis: diagnostic dilemma

2018 ◽  
Vol 100 (6) ◽  
pp. e158-e160
Author(s):  
HE Matar ◽  
P Stritch ◽  
S Connolly ◽  
N Emms
Keyword(s):  
Magnetic Resonance Imaging ◽  
Differential Diagnosis ◽  
Magnetic Resonance ◽  
Malignant Tumour ◽  
Resonance Imaging ◽  
Diagnostic Dilemma ◽  
Benign Condition ◽  
Calcific Myonecrosis ◽  
History Of ◽  
Growing Mass

Calcific myonecrosis is a rare benign condition affecting mainly the muscles of a single leg compartment. It is thought to follow a history of trauma with a latent period of years. Patients present with a slowly growing mass. Differential diagnosis from a malignant tumour can be made from the history and the distinctive radiographical features of a fusiform lesion with predominantly peripheral calcifications. Magnetic resonance imaging may be necessary to confirm the diagnosis; treatment is largely symptomatic.

scholarly journals Diagnostic Accuracy of Magnetic Resonance Cholangiopancreatography (MRCP) In-Patients Undergoing Endoscopic Retrograde Cholangiopancreatography (ERCP) for Pancreaticobiliary Disorders

2021 ◽  
pp. 119-124
Author(s):  
M. Vignesh Kumar
Keyword(s):  
Bile Duct ◽  
Magnetic Resonance ◽  
Common Bile Duct ◽  
Diagnostic Accuracy ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Periampullary Carcinoma ◽  
Endoscopic Retrograde ◽  
Common Cause ◽  
The Common ◽  
Study Participants

This is a prospective study done to compare the diagnostic accuracy of Magnetic Resonance Cholangiopancreatography (MRCP) in patients undergoing Endoscopic Retrograde Cholangiopancreatography (ERCP) for pancreaticobiliary disorders.Majority of the study participants were males (63.3%), while the rest 36.78% of them were females and periampullary carcinoma (11.7%) and common bile duct calculus (11.7%) are the common cause of obstruction found on MRCP followed by malignant stricture (10%). The extent of obstruction was determined in most of the study participants (91.7%) by MRCP while the rest 8.3% were not determined by MRCP. The Common bile duct calculus (11.7%) is the common cause of obstruction on ERCP followed by malignant stricture (10%) and Periampullary carcinoma (10%) and 20% of the patients were found to be normal in ERCP. Among them, 71.4 % did not show MRCP and the association was found to be significant. (p- Value < 0.00).

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