Omar Tageldin, MD, Rabah Alreshq, MD, Cassidy Alexandre, MD, Nour Parsa, MD; Albany Medical Center, Albany, NY
Introduction: Pancreatic pseudocyst is a rare cause of pleural effusion. It is typically related to a direct communication between the pleural cavity and the pseudocyst. Respiratory symptoms due to large pleural effusion may be the presenting symptoms to pancreatic pseudocyst. Pleural effusion due pancreatic pseudocyst is usually left sided but in rare occasions can present as right sided pleural effusion as reported in our case.
Methods: A 28-year-old morbid obese female with history of recurrent hypertriglyceridemia induced acute pancreatitis, DM2, and hypertension presented with 5-day history of worsening sharp epigastric abdominal pain radiating to the back associated with nausea but no vomiting or diarrhea. She denied any fever or chills. Her exam was significant for epigastric tenderness and dullness with decreased breath sounds on right lung base. All her laboratory data including liver function tests and lipase were within normal limits. A CT abdomen and pelvis with contrast showed a large pseudocyst in the pancreas measuring 15x10 cm and interestingly the pseudocyst was connected to a moderate-sized right-sided pleural effusion. She subsequently underwent upper endoscopic ultrasound (EUS) guided cystgastrostomy with Axios stent insertion to drain the large pancreatic pseudocyst. Her symptoms dramatically improved after the procedure and she was tolerating oral diet without any abdominal pain and she was discharged home on the next day. At six-month follow-up patient was tolerating oral diet without any abdominal pain, nausea or vomiting and exam was benign with normal breath sounds bilaterally. Discussion: Right-sided pleural effusion is a very rare complication of pancreatic pseudocyst. Pancreaticopleural fistula occurs in 6-14% of patients with pancreatic pseudocyst and can also be seen after percutaneous drainage of pseudocyst, abdominal trauma or pancreatic surgical resection. Abdominal symptoms are mostly predominant, but gastroenterologist should be aware that cases might present initially with respiratory symptoms including dyspnea, angina, or cough. Although magnetic resonance cholangiopancreatography (MRCP) is reported to be sensitive, CT scanning is cost effective, quick and helpful in diagnosing pleural effusion that is connected to pancreatic pseudocyst. Management usually depends on the predominant symptoms and include, thoracentesis, endoscopic drainage of pseudocyst or surgery if other measures failed.
CT scan of the abdomen showing large pancreatic pseudocyst (arrow)
CT scan of the abdomen showing a moderate-sized right-sided pleural effusion (arrow)
Follow up EGD showing collapsed pancreatic pseudocyst
Disclosures: Omar Tageldin indicated no relevant financial relationships. Rabah Alreshq indicated no relevant financial relationships. Cassidy Alexandre indicated no relevant financial relationships. Nour Parsa indicated no relevant financial relationships.