Liao Ying-Ting, Chiu Nai-Chi, Chen Chun-Ku, Su Kang-Cheng
Department of Chest Medicine Taipei Veterans General Hospital Taipei City Taiwan, Republic of China.
Department of Radiology Taipei Veterans General Hospital Taipei City Taiwan, Republic of China.
Respirol Case Rep. 2022 Mar 9;10(4):e0929. doi: 10.1002/rcr2.929. eCollection 2022 Apr.
The clinical course and severity of pancreatitis might vary largely. Pancreatitis-related thoracic complications might be life-threatening but frequently ignored. We report an alcoholic patient who initially presented to the emergency department with community-acquired pneumonia, acute respiratory failure and acute-on-chronic pancreatitis with massive pancreatic pleural effusion. Subsequently, he developed insidiously pancreatitis-related intra-abdominal, mediastinal pseudocysts, and unexpectedly sudden onset of cardiac tamponade. Although tamponade-related haemodynamic instability improved soon after timely diagnosis and emergent pericardial drainage, his recovery period was prolonged. His serum amylase and lipase were persistently elevated until definitive treatment with endoscopic retrograde cholangiopancreatography-assisted removal of pancreatic duct stones. Pancreatitis-related cardiac tamponade is rare but lethal without prompt diagnosis and management. We reviewed pancreatitis-related thoracic complications, particularly for cardiac tamponade, and discussed about the pathophysiology and management options.
胰腺炎的临床病程和严重程度可能差异很大。与胰腺炎相关的胸部并发症可能危及生命，但常常被忽视。我们报告一名酒精性胰腺炎患者，其最初因社区获得性肺炎、急性呼吸衰竭以及伴有大量胰性胸腔积液的慢性胰腺炎急性发作而就诊于急诊科。随后，他隐匿性地出现了与胰腺炎相关的腹腔内、纵隔假性囊肿，并且意外地突然发生心脏压塞。尽管在及时诊断和紧急心包引流后，与心脏压塞相关的血流动力学不稳定很快得到改善，但他的恢复期延长。在通过内镜逆行胰胆管造影辅助清除胰管结石进行确定性治疗之前，他的血清淀粉酶和脂肪酶持续升高。与胰腺炎相关的心脏压塞很少见，但如果不及时诊断和处理则会致命。我们回顾了与胰腺炎相关的胸部并发症，尤其是心脏压塞，并讨论了其病理生理学和处理方法。
