Endoscopic therapy of a pancreatic effusion caused by chronic pancreatitis

A 36-year-old patient was hospitalized because of an extensive right pleural effusion. He complained of increasing dyspnea, moderate weight loss and night sweats. The pleural aspirate was hemorrhagic and, surprisingly, excessively elevated lipase activity (57,000 U/L) was measured. An ultrasound examination of the epigastric area revealed several cystic structures in the upper retroperitoneum, and CT scan additionally showed diffuse pancreatic calculi. After conservative treatment had failed, ERCP was performed. A pseudocyst and the indistinct outline of a stenosis of the pancreatic duct could be seen. A few fragments of calculi were removed and a pancreatic duct stent was positioned. Because of stent occlusion ERCP was repeated and some more calculi were extracted, after which the pleural effusion and the pseudocysts completely regressed. In cases of pleural effusion on unclear etiology, a pancreatic pleural effusion should be included in the differential diagnosis. In patients with this clinical picture ERCP can provide not only diagnostic information, but also opportunities for new modes of treatment.