Lam Stephen, Banim Paul
Department of General Surgery, James Paget Hospital, Great Yarmouth, UK.
BMJ Case Rep. 2014 Apr 9;2014:bcr2014204032. doi: 10.1136/bcr-2014-204032.
A 47-year-old man with a history of alcohol-related pancreatitis was admitted with dyspnoea due to a moderate right-sided pleural effusion. Diagnostic pleural tap showed an amylase of 6078 U/L. CT demonstrated a pancreatic pseudocyst with communication to the pleural cavity. Conservative medical management and chest drainage were started, but after 13 days the patient became acutely unwell with severe dyspnoea and worsening chest pain. Chest X-ray and subsequent CT demonstrated a massive pleural effusion with mediastinal shift. Ultrasound scan demonstrated loculation of the effusion requiring insertion of a large bore chest drain to relieve symptoms. He was transferred to a pancreaticobiliary centre, but subsequently made a good recovery without the need for a further procedure. This case highlights massive pleural effusion with subsequent loculation as a rare complication of chronic pancreatitis.
一名有酒精相关性胰腺炎病史的47岁男性因中度右侧胸腔积液伴呼吸困难入院。诊断性胸腔穿刺显示淀粉酶水平为6078 U/L。CT显示胰腺假性囊肿与胸腔相通。开始进行保守药物治疗和胸腔引流，但13天后患者病情急剧恶化，出现严重呼吸困难和胸痛加重。胸部X线及后续CT显示大量胸腔积液伴纵隔移位。超声检查显示积液有分隔，需要插入大口径胸腔引流管以缓解症状。他被转至胰胆中心，但随后恢复良好，无需进一步手术。该病例强调了大量胸腔积液伴随后的积液分隔是慢性胰腺炎的一种罕见并发症。
