Suspected Pancreatic-Pleural Fistula Presenting With Massive Pleural Effusion Complicated by Fatal Re-expansion Pulmonary Edema

Pancreatic-pleural fistula (PPF) and re-expansion pulmonary edema (RPE) are rare but potentially fatal complications of pancreatitis. This report describes a 31-year-old man with a history of recurrent alcohol-associated pancreatitis who presented with acute hypoxic respiratory failure due to a large pleural effusion. Chest tube drainage revealed amylase-rich fluid, highly suggestive of a PPF. Rapid drainage of a large volume of pleural fluid precipitated RPE, followed by rapid clinical deterioration and cardiac arrest. This case highlights the importance of recognizing suspected PPF as a cause of large pleural effusions and the need for cautious drainage to prevent life-threatening complications such as RPE. To date, the coexistence of PPF complicated by fatal RPE has rarely been reported.