A surprising diagnosis of pancreatitis with pseudocyst associated with sudden massive effusion

Abstract

This article describes the case of a 40 year-old man presenting with pleuritic pain on the right side, cough, sputum and sweating symptoms. He had smoked 40 pack-years of cigarettes and consumed 140 ml alcohol/day for 20 years. Breath sounds were diminished at the right lung base. Chest X-ray showed right hemi-diaphragm elevation and heterogeneous opacity on the right inferior zone. Antibiotherapy was commenced for possible diagnosis of pleuropnemonia. The patient developed dyspnea after a few days. Right hemithorax filled with a parabolic shadow was observed on the chest X-ray. Serosanguineous exudate was sampled. Very high levels of amylase and lipase levels were detected in the pleural fluid. Furthermore, magnetic resonance imaging revealed pancreatic pseudocyst near the left diaphragmatic crus. Four thousand milliliters of pleural fluid was drained using an intercostal drain within a 4-day period, and chest symptoms were relieved. Upon follow-up, suitable therapy for chronic pancreatitis was administered, and the patient was stable without any recurrence.