Bhandari Kritick, Sen Kamana, Rijal Prabhat, Ghimire Sagun
KIST Medical College and Teaching Hospital Lalitpur Nepal.
Department of Internal Medicine KIST Medical College and Teaching Hospital Lalitpur Nepal.
Clin Case Rep. 2025 Jan 26;13(2):e70151. doi: 10.1002/ccr3.70151. eCollection 2025 Feb.
Hemorrhagic pleural effusion as the sole manifestation of pancreatitis is exceedingly rare and often presents diagnostic challenges due to its misleading symptoms. We report the case of an adult male with a large left-sided black pleural effusion secondary to chronic necrotizing pancreatitis. The patient presented with progressive shortness of breath and cough, with a history of alcohol use and a previous diagnosis of acute severe pancreatitis. Initial assessment revealed significant respiratory distress and imaging confirmed massive pleural effusion. Pleural fluid analysis and subsequent imaging identified chronic necrotizing pancreatitis as the cause. Immediate management with thoracentesis, pleural drainage, and conservative treatment with fluids and antibiotics led to significant clinical improvement. This case highlights the importance of thorough clinical evaluation and timely intervention in managing rare presentations of pancreatic diseases. Effective treatment with chest tube drainage and conservative pancreatitis management can yield positive outcomes even in severe cases. Despite the rarity of pleural effusion due to chronic pancreatitis, clinicians should maintain a high index of suspicion, particularly in patients with a relevant history, to ensure prompt and appropriate management.
出血性胸腔积液作为胰腺炎的唯一表现极为罕见，且因其具有误导性的症状常常带来诊断挑战。我们报告一例成年男性病例，其因慢性坏死性胰腺炎继发左侧大量黑色胸腔积液。该患者表现为进行性气短和咳嗽，有饮酒史且既往诊断为急性重症胰腺炎。初始评估显示有明显的呼吸窘迫，影像学检查证实有大量胸腔积液。胸腔积液分析及后续影像学检查确定慢性坏死性胰腺炎为病因。立即进行胸腔穿刺、胸腔引流，并采用补液和抗生素进行保守治疗，使临床症状有显著改善。该病例凸显了全面临床评估和及时干预在处理罕见胰腺疾病表现中的重要性。即使在严重病例中，胸腔闭式引流和保守性胰腺炎管理的有效治疗也可产生积极结果。尽管慢性胰腺炎导致的胸腔积液罕见，但临床医生应保持高度怀疑指数，尤其是对有相关病史的患者，以确保及时且恰当的处理。
