Pancreatic Pleural Effusion Accompanied by Bronchopleural Fistula
Toshiyasu Sakurai1) Riyo Fujiyama1) Hisashi Ohnishi1) Kimihide Tada1) Hiromi Tomioka1) Hiroko Sakamoto1) Hironobu Iwasaki1) Minoru Aoki2)
Department of Respiratory Medicine1), Department of Thoracic Surgery2), Nishi-Kobe Medical Center, 5-7-1 Koujidai, Nishi-ku, Kobe, Japan
In recent years, chronic massive pleural effusions have been increasingly recognized as a serious complication of pancreatitis. We describe the third reported case of a pancreatic pleural effusion accompanied by bronchopleural fistula. A 49-year-old man suffering from chronic alcohol-related pancreatitis was admitted to our hospital complaining of cough and shortness of breath. A chest x-ray film disclosed a large right pleural effusion with an air-fluid level. Ultrasonography and computed tomography of the upper abdomen demonstrated a giant pancreatic pseudocyst in the pancreatic tail and a fistulous tract reaching into the posterior mediastinum via the esophageal hiatus. Thoracentesis revealed sterile hemorrhagic fluid with markedly elevated amylase activity of 20,955 IU/l (pancreatic isozyme, 100%) and no malignant cells. A diagnosis of pancreatic pleural effusion was made. The therapy for pancreatic internal fistula is somewhat controversial. We employed conservative therapy, including hyperalimentation and chest tube drainage that successfully decreased the pleural effusion and closed the fistulous tract. Nonetheless, we were still troubled by a continuous air-leak via the drainage tube. Pleurodesis confirmed the tentative diagnosis of bronchopleural fistula and successfully stopped the air-leak. No re-accumulation of pleural effusion has been seen for 2 years. We concluded that pancreatic enzyme-rich effusions, if long-standing, may be complicated by bronchopleural fistula, thus underscoring the need for urgent drainage and initially conservative management.
Pleural effusion Pancreatitis Pneumothorax Bronchopleural fistula
Received 平成11年1月18日
JJRS, 37(8): 662-666, 1999