Abstract Introduction Pleuropancreatic fistula (PPF) is a rare complication of chronic or severe acute pancreatitis, typically associated with left-sided pleural effusions. We present a unique case of a right-sided pleural effusion secondary to a pleuropancreatic fistula, highlighting an unusual presentation of an uncommon complication of pancreatitis. Case Presentation A 45-year-old African American male with a history of chronic pancreatitis since 2017 presented with abdominal pain after running out of his pancreatic enzyme replacement therapy. He reported 1 week of intermittent epigastric pain of 10/10 severity. He also had a 1-month history of progressive shortness of breath without chest pain. Denied any chest pain. He denied a recent history of trauma or pulmonary infections. Physical examination revealed absent breath sounds on the right side and dullness to percussion.A chest X-ray showed a large right-sided pleural effusion. CT Chest showed a similar large right-sided pleural effusion and emphysematous changes in the left lung. A chest tube was inserted, and 1.5L of dark green to brown-colored pleural fluid was drained. Pleural fluid was dark green in color. Pleural fluid analysis revealed an LDH of 515 and an amylase level of 21,000, suggesting a pancreatic origin. A contrast-enhanced computed tomography (CT) scan of the abdomen was negative for any tumor or mass. He was evaluated by the gastroenterology team with a strong suspicion of pleuropancreatic fistula, for which a Magnetic Resonance Cholangiopancreatography (MRCP) was done, confirming the presence of this fistula. Discussion Pleuropancreatic fistulae commonly present with left-sided pleural effusions due to the anatomical proximity of the pancreas to the left hemidiaphragm. Right-sided effusions are exceedingly rare and may be overlooked due to their atypical presentation. This case highlights the importance of considering hepatobiliary and pancreatic etiologies for unexplained pleural effusions in patients with a history of intra-abdominal disease. Conclusion This case highlights an unusual manifestation of pleuropancreatic fistula with a right-sided pleural effusion, emphasizing the need for a high index of suspicion and multimodal imaging for accurate diagnosis. Early recognition and a multidisciplinary approach to management can optimize patient outcomes. This abstract is funded by: None
Ikwu et al. (Fri,) studied this question.