Pancreaticopleural Fistula Presenting as Left Neck Swelling

Pancreaticopleural fistula is an uncommon complication of pancreatitis. It results from communication of the pancreatic duct to the pleural space. The authors describe a case of a 54-year-old man with a history of alcohol abuse and chronic pancreatitis, who presented with left neck swelling, dysphagia, and dyspnea. Computed tomography imaging revealed right pleural effusion and multiloculated fluid collections in and around the pancreas and retroperitoneum with extension through the posterior mediastinum into the left neck. Analysis of the neck aspirate and the pleural effusion showed very elevated amylase levels. This is the first known case of a pancreaticopleural fistula presenting as neck swelling due to cystic fluid collection.