Chest
Pulmonary and Critical Care PearlsRecurrent Left Pleural Effusion in a 44-Year-Old Woman With a History of Alcohol Abuse
Section snippets
Physical Examination
Vital signs: afebrile; pulse, 80 beats per minute; BP, 120/80 mm Hg. Chest: decreased breath sounds at both bases; dullness to percussion two thirds up the left side; decreased fremitus on left. Abdomen: normal active bowel sounds; no tenderness, palpable masses, or hepatosplenomegaly; no stigmata of chronic liver disease.
Laboratory Findings
WBC counts: 10,000/pL with 80% neutrophils; hemoglobin, 14 g/dL; platelets, 240,000/pL. Pleural fluid analysis: pH, 7.46; protein, 3.7 g/dL; amylase, 26,020 IU/L; and lipase,
CLINICAL PEARLS
- 1.
The presentation of pancreaticopleural fistula is often confusing with a predominance of pulmonary symptoms and a relative absence of abdominal complaints. Often the patient has no previous history of pancreatic disease.
- 2.
A pancreaticopleural fistula should be suspected in a patient with a history of alcoholism and a chronic pleural effusion.
- 3.
The most striking laboratory feature is the presence of an exudative pleural effusion with markedly elevated pleural fluid amylase and lipase level.
- 4.
References (0)
Cited by (15)
Pancreatic-pleural fistula: The role of ERCP in diagnosis and treatment
2000, Gastrointestinal EndoscopyPancreaticopleural fistula in chronic pancreatitis: Resolution with endoscopic therapy
2000, Gastrointestinal EndoscopyCitation Excerpt :In a review of 113 cases from Japan, only 23 patients had complaints of epigastric pain and only 12% had associated pancreatic ascites.1 The diagnosis should be considered in a patient with new left-sided pleural effusion and a history of pancreatitis and/or alcohol abuse.7 In 98% of the cases in the review from Japan, there was a history of chronic alcoholism.
Investigation of a unilateral pleural effusion in adults: British Thoracic Society pleural disease guideline 2010
2010, ThoraxCitation Excerpt :If oesophageal rupture is entertained as a differential diagnosis, urgent more specific investigation by contrast radiography or endoscopy is indicated. There are few data regarding the measurement of pleural fluid lipase, although case reports of pleural effusions secondary to pancreatitis have described its elevation alongside amylase.66 If malignancy is suspected, cytological examination of the pleural fluid is a quick and minimally invasive way to obtain a diagnosis.
Biochemical analysis of pleural fluid and ascites
2018, Clinical Biochemist ReviewsA surprising diagnosis of pancreatitis with pseudocyst associated with sudden massive effusion
2011, Experimental and Therapeutic Medicine