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      Hemorrhagic pleural effusion due to pseudo-pancreatic cyst

      case-report

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          Abstract

          Hemorrhagic pleural effusion is a common clinical entity still diagnosis is often missed. An unusual and often over-looked cause of pleural effusion is an intra-abdominal process including complication arising due to pancreatitis. We report a rare case of massive left sided hemorrhagic pleural effusion in a patient due to pancreatic pathology.

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          Pancreaticopleural fistula. Report of 7 patients and review of the literature.

          J Cello, D Rockey (1990)
          Pancreaticopleural fistula is an uncommon clinical condition. Its presentation is often confusing because of the paucity of clues suggestive of pancreatic disease and the preponderance of pulmonary symptoms and signs. Most patients are alcoholics but only one-half will have a clinical history of previous pancreatitis. Pleural effusions are large, recurrent, and highly exudative in nature. Many patients go through extensive pulmonary evaluation before the pancreas is identified as the site of primary pathology. An elevated serum amylase may be the first clue to the diagnosis. However, the key to the diagnosis is a dramatically elevated pleural fluid amylase. Effusions in association with acute pancreatitis, esophageal perforation, and thoracic malignancy are important to consider in the differential diagnosis of an elevated pleural fluid amylase but are usually easy to exclude. Computed tomography is excellent in defining pancreatic abnormalities and should be the first abdominal imaging study in suspected cases. Endoscopic retrograde cholangiopancreatography (ERCP) is used as a diagnostic tool only in confusing cases. Although no systematic study evaluates medical versus surgical therapy, we recommend an initial 2 to 4-week trial of medical therapy, including allowance of no oral intake, total parenteral nutrition, chest tube thoracostomy, and possibly a regimen of somatostatin or its analogs. The major complication in these patients is superinfection, which results in significant morbidity and mortality. Failure of medical therapy should be considered failure of pleural effusion(s) to clear, recurrence after reinstatement of oral intake, or superinfection. For those patients who fail to benefit from medical therapy, surgery is indicated.(ABSTRACT TRUNCATED AT 250 WORDS)
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            Nonsurgical management of pancreaticopleural fistula.

            Alhad R Dhebri, Nicholas A Ferran (2005)
            Pancreaticopleural fistula is seen in acute and chronic pancreatitis or after traumatic or surgical disruption of the pancreatic duct. Surgery leads to healing in 80-90% of cases but carries a mortality of up to 10%. Our aim was to assess the management of pancreaticopleural fistula on a specialist pancreatic Unit. Patients presenting with pancreaticopleural fistulae were identified from acute and chronic pancreatitis databases. Management and outcome were compared with previous studies identified in MEDLINE and EMBASE. Four patients presented with dyspnoea from large unilateral pleural effusions. Three had a history of alcohol abuse and one of asymptomatic gallstones. All were treated with chest drainage, octreotide and endoscopic retrograde cholangiopancreatography plus/minus pancreatic stent. Two had a pancreatic stent in situ for 5 and 8.5 months respectively. In the third sphincterotomy was performed; in the fourth the pancreatic duct could not be cannulated. The fistula healed in all cases, with no recurrence after 12-30 months, and no deaths. There are 14 reports including 16 cases treated with endoscopic retrograde cholangiopancreatography plus/minus pancreatic stent in the literature, with no recurrence after follow up ranging 4-30 months and no deaths in these 16 cases. A high index of suspicion is necessary to be aware of its presence. These data suggest that endoscopic management is preferable alternative to surgery for pancreaticopleural fistula.
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              Pleural effusion: laboratory tests in 300 cases.

              Jana A Hirsch, M Nebut, Y-J Bignon … (1979)
              The cause of pleural effusion was studied in 300 consecutive patients by clinical examination and laboratory tests. The three most common causes were found to be cancer 117 cases (metastatic 65, bronchogenic 34, mesothelioma 10, lymphoma 7, other 1); tuberculous infection 53; and bacterial infection 38. The cause was not found in 62 patients. Cancer diagnosis was established by cytological examination of pleural fluid (63), closed pleural biopsy (37), and open pleural biopsy (11). Tuberculosis was diagnosed by culture of pleural fluid (12), closed pleural biopsy (38), and open pleural biopsy (3). In cases of empyema 12 Gram-positive and two Gram-negative cocci and two anaerobes were identified. The various causes and the usefulness of the different investigative procedures are discussed, and the data evaluated in the light of current knowledge about mechanisms of transfer through the pleural space.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Adv Biomed Res
                Journal ID (iso-abbrev): Adv Biomed Res
                Journal ID (publisher-id): ABR
                Title: Advanced Biomedical Research
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Electronic): 2277-9175
                Publication date Collection: 2016
                Publication date (Electronic): 16 March 2016
                Volume: 5
                Electronic Location Identifier: 42
                Affiliations
                [1]Department of TB and Respiratory Medicine, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India
                [1 ]Department of Community Medicine, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India
                Author notes
                Address for correspondence: Dr. Ruchi Sachdeva, Department of TB and Respiratory Medicine, Pt. B.D. Sharma PGIMS, Rohtak - 124 001, Haryana, India. E-mail: drsachdeva@ 123456hotmail.com
                Article
                Publisher ID: ABR-5-42
                DOI: 10.4103/2277-9175.178789
                PMC ID: 4815531
                PubMed ID: 27099855
                SO-VID: 53fd44a2-d85b-4703-b9fe-fbd3173b366c
                Copyright © Copyright: © 2016 Advanced Biomedical Research
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

                History
                Date received : 20 May 2013
                Date accepted : 04 July 2015
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Molecular medicine
                Keywords: abdomen,alcohol,bleeding,chest pain,fistula,neoplasm,pancreas,trauma
                Data availability:
                ScienceOpen disciplines: Molecular medicine
                Keywords: abdomen, alcohol, bleeding, chest pain, fistula, neoplasm, pancreas, trauma

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