Sonoda Shiro, Taniguchi Miki, Sato Tomohide, Yamasaki Motohisa, Enjoji Megumu, Mae Sunao, Irie Tetsuya, Ina Hiroyasu, Sumi Yuki, Inase Naohiko, Kobayashi Takayoshi
Internal Medicine, Nakano General Hospital, Japan.
Intern Med. 2012;51(18):2655-61. doi: 10.2169/internalmedicine.51.7859. Epub 2012 Sep 15.
A 53-year-old man developed bilateral pleural effusion with respiratory failure. The amylase level in the pleural effusion was elevated. He had neither abdominal symptoms nor abdominal physical findings. Abdominal computed tomography (CT) also showed no abnormalities. Magnetic resonance cholangiopancreatography (MRCP) was non-diagnostic, but endoscopic retrograde cholangiopancreatography (ERCP) and subsequent CT showed a fistula connecting the pancreatic duct with the right pleural cavity. The pleural effusion was refractory to drug therapy, leading to the need for surgical intervention. The pathological findings revealed chronic pancreatitis without pseudocysts. The elevated pancreatic amylase in the pleural effusion offered an important clue to the correct diagnosis.
一名53岁男性出现双侧胸腔积液并伴有呼吸衰竭。胸腔积液中的淀粉酶水平升高。他既没有腹部症状，腹部体格检查也未发现异常。腹部计算机断层扫描（CT）也未显示异常。磁共振胰胆管造影（MRCP）未能明确诊断，但内镜逆行胰胆管造影（ERCP）及随后的CT显示存在一条连接胰管与右胸腔的瘘管。胸腔积液对药物治疗无效，因此需要进行手术干预。病理检查结果显示为无假性囊肿的慢性胰腺炎。胸腔积液中升高的胰腺淀粉酶为正确诊断提供了重要线索。
