[Pleural effusion indicator of pancreatitis]

The presence of a pleural effusion in patients with pancreatitis is a common marginal occurrence. On rare occasions the pleural effusion not only is abundant, recurrent, hemorrhagic and contains a high concentration of amylase, but presents as the only manifestation of an otherwise undiagnosed or obscure pancreatitis. Thus it presents a difficult diagnostic and therapeutic problem. The authors report such a case and review the literature in which 49 cases have been reported in the past 10 years. Pancreatomediastinopleural fistula is usually visualized and seems to be the basic fault in most cases. Thoracic drainage will relieve the patient and dry up the effusion in one third of cases. Otherwise pancreatic resection is usually required. Internal or external drainage of the mediastinopleural component by laparotomy is not difficult. Pleural sequelae are minimal in most cases.