Chronic pancreatitis complicated by pancreatico-pleural fistula leading to black pleural effusion: a case report

Pancreaticopleural fistula, a rare but serious complication of chronic pancreatitis, typically presents with recurrent massive hemorrhagic pleural effusion. Respiratory symptoms dominate the clinical picture, while abdominal signs are often subtle. A 43-year-old male was admitted with a 5-day history of chest tightness. Chest computed tomography (CT) revealed massive left pleural effusion. Thoracentesis yielded black pleural fluid, but routine analysis was inconclusive. Given the patient’s history of alcohol abuse and chronic abdominal distension, an abdominal CT was performed, showing atrophy and multiple calcifications in the body and tail of the pancreas. Serum and pleural fluid amylase levels were measured at 354 U/L and > 6000 U/L, respectively. Contrast-enhanced upper abdominal CT and magnetic resonance cholangiopancreatography‌ (MRCP) further demonstrated a fistula extending from the pancreas to the left pleural cavity. The patient was diagnosed with chronic pancreatitis, pancreaticopleural fistula, and pancreas-related pleural effusion. Treatment included thoracic drainage, parenteral nutrition, and intravenous administration of somatostatin and omeprazole to reduce pancreatic secretion. The patient’s condition improved significantly. Patients with chronic pancreatitis complicated by pancreaticopleural fistula may present predominantly with respiratory symptoms and lack significant abdominal manifestations, which can lead to missed or delayed diagnosis. A markedly elevated amylase level in pleural fluid serves as a crucial diagnostic clue. Confirmation of pancreaticopleural fistula can be achieved through upper abdominal imaging evaluation.