[Pleuro-pulmonary manifestation of pancreatic diseases]

Non-neoplastic pancreatic disorders may cause pleuro-pulmonary signs. In acute pancreatitis respiratory disorders are very frequent and may cause simply an hypoxia or the adult respiratory distress syndrome (SDRA). There is no single mechanism: mechanical hypoventilation, alteration of the vessel walls and interstitial oedema, stasis of leucocytes, alterations in surfactant and intravascular coagulation may all contribute. These disturbances may be made by direct action of enzymes or by the intermediary of the activation of the kinine system, of complement activation and of coagulation mechanisms. In chronic pancreatitis the problem is to diagnose the cause of the pleural effusion which may often appear to be primary. The cause is suggested by a raised pleural amylase, type P. Although neoplastic pleural effusions may sometimes be rich in amylase it is of type S. The diagnosis rests on echos, computerised scans and retrograde cholangeopancreatography. The pathophysiology of these effusions is through the passage on the enzymes by the lymphatic route, by the oesophageal and aortic route or by a pancreatico-pleural fistula.