Massive Hemorrhagic Pleural Effusion as the Sole Manifestation of Pancreatitis: A Case Report and Review of Literature

Introduction: Hemorrhagic pancreatic pleural effusion (PPE) as an isolated manifestation of pancreatitis is exceedingly rare and often overlooked.While pleural effusion in acute pancreatitis is typically mild and self-limiting, massive or hemorrhagic effusions suggest a more complex pathology requiring prompt intervention.We report a case of a 29-year-old male who presented with massive left-sided hemorrhagic pleural effusion, later found to be due to acute pancreatitis with pancreatic pseudocysts.Case description: A 29-year-old male with a history of alcohol use and recent acute pancreatitis presented with exertional breathlessness, left shoulder pain, and significant weight loss.Radiological evaluation revealed massive left-sided hemorrhagic pleural effusion with elevated pleural fluid amylase suggestive of pancreatic origin.He was managed with intercostal drainage, subcutaneous octreotide, and later underwent endoscopic drainage of a pancreatic pseudocyst.His condition improved significantly, with resolution of the pleural effusion and removal of the chest tube.Conclusion: This case underscores the importance of including pancreatitis in the differential diagnosis of pleural effusion and highlights the effectiveness of timely conservative and interventional management in preventing complications such as fluid reaccumulation and respiratory failure.