Abstract Introduction Pancreaticopleural fistulas (PPFs) are a rare complication of pancreatitis, arising when pancreatic fluid leaks into the pleural cavity through an abnormal connection between the pancreatic duct and the thoracic space. This typically occurs due to a disruption of the pancreatic duct or rupture of a pancreatic pseudocyst, resulting in recurrent or massive pleural effusions. PPFs are estimated to occur in approximately 0.4% of all pancreatitis cases and in up to 4.5% of patients with pancreatic pseudocysts. Despite their clinical significance, they remain a rare complication. PPFs most frequently occur in the setting of chronic pancreatitis, particularly in patients with alcohol-related disease. The condition shows a male predominance, and left-sided pleural effusions are more commonly observed, reflecting the typical anatomical course of the pancreatic duct and fistulous tract. Description This is the case of a 61-year-old woman with a history of chronic pancreatitis and pancreatic pseudocyst formation who was admitted with progressive shortness of breath and pleuritic chest pain. Initial chest x-ray imaging revealed a large left-sided pleural effusion. Subsequent CT imaging of the thorax, abdomen, and pelvis demonstrated a fluid-filled tract extending from the pancreas toward the oesophageal diaphragmatic hiatus, raising suspicion for a PPF. Diagnostic thoracentesis revealed a blood-stained pleural effusion with an markedly elevated amylase level of 48,709 IU/L, strongly suggestive of a pancreatic origin. Pleural fluid analysis showed low protein (30 g/L) and a significantly elevated LDH (748 IU/L), more than three times the serum LDH, consistent with an exudative effusion by Light’s criteria. A chest drain was inserted to facilitate pleural fluid drainage. Definitive management involved endoscopic placement of a pancreatic duct stent, which successfully diverted pancreatic secretions and promoted closure of the fistula. Discussion This case highlights a rare but important complication of chronic pancreatitis. It underscores the diagnostic value of measuring pleural fluid amylase in patients with known pancreatic disease presenting with unexplained pleural effusions. This abstract is funded by: None
McDermott et al. (Fri,) studied this question.