Pancreaticopleural fistula, a rare mediastinal emergency

Am J Emerg Med. 2021 Jun:44:477.e1-477.e3. doi: 10.1016/j.ajem.2020.10.032. Epub 2020 Oct 21.

Abstract

A pancreaticopleural fistula (PPF) is a rare condition that causes thoracic symptoms such as dyspnea and chest pain secondary to exudative pleural effusions. While PPF is a very rare complication with only 52 cases reported between 1960 and 2007, they typically occur in patients who are male, middle aged, and have a history of chronic alcohol use and chronic pancreatitis (Aswani and Hira, 2015; Francisco et al., n.d.; Valeshabad et al., 2018; Ali et al., 2009). The fistula between the pancreas and pleural cavity causes large, rapidly accumulating, and recurrent pleural effusions which cause symptoms that can be difficult to differentiate from other acute thoracic pathologies (Francisco et al., n.d.). As a result, it is essential that providers have a high index of suspicion for PPF in these appropriate populations. We present a case study to review the typical presentation, pathophysiology, and current approach to treatment of PPF. This case is unique as the patient had no known risk factors. Due to limited data on this topic, there are no evidence-based guidelines on this topic, leaving a variety of case reports to inform clinical management in the emergency department.

Keywords: Chest pain; Mediastinum; Pancreaticopleural fistula; Pancreatopleural fistula.

Publication types

  • Case Reports

MeSH terms

  • Biomarkers / blood
  • Combined Modality Therapy
  • Diagnosis, Differential
  • Drainage
  • Drug Therapy, Combination
  • Emergency Service, Hospital
  • Fistula / diagnostic imaging
  • Fistula / therapy*
  • Humans
  • Male
  • Middle Aged
  • Pancreatic Fistula / diagnostic imaging
  • Pancreatic Fistula / therapy*
  • Pleural Diseases / diagnostic imaging
  • Pleural Diseases / therapy*
  • Pleural Effusion / diagnostic imaging
  • Pleural Effusion / therapy
  • Tomography, X-Ray Computed

Substances

  • Biomarkers