A rare presentation of pleural pseudocyst in chronic calcific pancreatitis: A case report

Chronic calcific pancreatitis (CP) is a progressive inflammatory disorder that can lead to complications in multiple organ systems. Pleural pseudocysts, a rare thoracic manifestation of chronic pancreatitis, pose significant diagnostic and therapeutic challenges. This case report highlights the presentation, diagnostic approach, and management of a patient with pleural pseudocyst associated with chronic calcific pancreatitis. A 41-year-old male presented with a one-month history of abdominal pain and a persistent cough. Clinical evaluation and imaging revealed chronic calcific pancreatitis with multiple pseudocysts, left-sided hydropneumothorax, a right pleural pseudocyst, and massive ascites. Diagnostic imaging, including high-resolution computed tomography (HRCT) of the thorax and contrast-enhanced computed tomography (CECT) of the abdomen, confirmed the diagnosis. Biochemical analysis showed elevated amylase levels in pleural and ascitic fluids, consistent with pseudocyst rupture. The patient was managed conservatively with intercostal drain (ICD) insertion, pigtail catheterization, nasojejunal feeding, and broad-spectrum antibiotics. Despite stabilization, the patient declined further surgical interventions, including decortication and endoscopic retrograde cholangiopancreatography (ERCP). This case underscores the importance of a multidisciplinary approach in managing rare complications of chronic pancreatitis. Advanced imaging and biochemical analysis are pivotal for diagnosis, while nutritional optimization and minimally invasive interventions form the cornerstone of management. Definitive surgical or endoscopic procedures are often required but may be limited by patient preferences or resource constraints. Pleural pseudocyst is a rare but significant complication of chronic pancreatitis requiring prompt diagnosis and tailored management. This report emphasizes the role of a patient-centric approach in addressing complex clinical scenarios.