A Rare Case of Pancreaticopleural Fistula

Pancreaticopleural fistulas are a rare complication of acute or chronic pancreatitis, pancreatic trauma, or complicated pancreatic pseudocyst rupture. It accounts for less than 1% of all cases resulting in pleural effusions and is seen in approximately 7% of patients with chronic pancreatitis and in 14% of patients with pseudocyst. Persistent pancreatic secretions result in erosion of neighboring tissue. Left sided effusions are more common than right sided effusion, accounting up to 76%. Pathophysiology incompletely formed or ruptured pseudocyst. The fistulous tract passes either through the sternocostal triangle, the caval hiatus or directly through the defects aortic or esophageal diaphragmatic orifice. If the pancreatic duct disruption occurs anteriorly, a pancreaticoperitoneal fistula will develop that will manifest as ascites. If the disruption develops posteriorly, pancreatic secretion will flow into retroperitoneum and may dissect through the diaphragm into mediastinum and form a pleural fistula or present as mediastinal pseudocyst. We present a case of a large bilateral pleural effusion secondary to a pancreaticopleural fistula in a patient with multiple risk factors.