Pancreaticopleural fistula causing recurrent bilateral pleural effusions: A case report

Pancreaticopleural fistula (PPF) is an infrequent etiology of pleural effusion, characterized by nonspecific thoracic symptoms, which often leads to misdiagnosis and subsequent severe complications. Consequently, early diagnosis is crucial for effective management and the prevention of adverse outcomes. This report presents a rare case of PPF causing bilateral pleural effusions, aiming to enhance clinical recognition of this condition.

A 51-year-old male with a history of hepatitis B, pulmonary tuberculosis, and chronic pancreatitis presented with recurrent chest tightness, dyspnea, and significant weight loss. He had undergone multiple hospitalizations for pleural effusions with no definitive diagnosis.

The patient exhibited a marked increase in amylase levels within the pleural effusion, and magnetic resonance cholangiopancreatography revealed a pancreatic pseudocyst herniating into the mediastinum. Endoscopic retrograde cholangiopancreatography (ERCP) demonstrated mild dilation of the pancreatic duct, leading to a definitive diagnosis of PPF.

Despite initial conservative measures, including thoracentesis, antimicrobial therapy, and somatostatin analogs, the patient continued to experience persistent pleural effusion. Ultimately, ERCP with pancreatic duct stent placement was performed, leading to a significant improvement in the patient's condition.

Re-evaluation 2 months postdischarge using a thoracoabdominal computed tomography scan confirmed near-complete resolution of the pancreatic pseudocyst, absence of pleural effusion, and normalization of pancreatic function.

This case underscores the importance of a multidisciplinary approach in diagnosing and managing PPF. It highlights the utility of ERCP in both diagnosing and treating PPF and the need for early recognition to prevent diagnostic delays and improve patient outcomes.