Kaye M D
Thorax. 1968 May;23(3):297-306. doi: 10.1136/thx.23.3.297.
Pancreatitis, in common with many other upper abdominal diseases, often leads to pleuropulmonary complications. Radiological evidence of pleuropulmonary abnormality was found in 55% of 58 cases examined retrospectively. The majority of such abnormalities are not specific for pancreatitis; but a particular category of pleural effusions, rich in pancreatic enzymes, is a notable exception. A patient with this type of effusion, complicated by a spontaneous bronchopleural fistula and then by an empyema, is reported. The literature relating to pancreatic enzyme-rich pleural effusions (pathognomonic of pancreatitis) is reviewed. Of several possible mechanisms involved in pathogenesis, transdiaphragmatic lymphatic transfer of pancreatic enzymes, intrapleural rupture of mediastinal extensions of pseudocysts, and diaphragmatic perforation are the most important. The measurement of pleural fluid amylase, at present little employed in this country, has considerable diagnostic value. Enzyme-rich effusions are more commonly left-sided, are often blood-stained, are frequently associated with pancreatic pseudocysts, and—if long standing—may be complicated by a bronchopleural fistula.
胰腺炎与许多其他上腹部疾病一样，常导致胸膜肺部并发症。回顾性检查的58例病例中，55%发现有胸膜肺部异常的影像学证据。大多数此类异常并非胰腺炎所特有；但富含胰酶的一类胸腔积液是一个显著例外。本文报告了一名患有此类胸腔积液的患者，该积液并发自发性支气管胸膜瘘，继而发展为脓胸。对与富含胰酶的胸腔积液（胰腺炎的特征性表现）相关的文献进行了综述。在发病机制涉及的几种可能机制中，胰酶经膈肌淋巴管转移、假性囊肿纵隔延伸的胸膜内破裂以及膈肌穿孔最为重要。目前我国很少使用的胸腔积液淀粉酶测定具有相当大的诊断价值。富含酶的胸腔积液更常见于左侧，常为血性，常与胰腺假性囊肿相关，且如果长期存在，可能并发支气管胸膜瘘。
