Massive right-sided hemorrhagic pleural effusion due to pancreatitis; a case report

Mohammad Reza Namazi,Ashkan Mowla

doi:10.1186/1471-2466-4-1

Mohammad Reza Namazi, Ashkan Mowla

Open Access

https://doi.org/10.1186/1471-2466-4-1

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Abstract

BackgroundHemorrhagic pleural effusion, especially in the right hemithorax rarely occurs as the sole presentation of pancreatitis.Case PresentationThis article reports massive right-sided hemorrhagic pleural effusion as the sole manifestation of pancreatitis in a 16-year-old Iranian boy. The patient referred to Nemazee Hospital, the main hospital of southern Iran, with right-sided shoulder and chest pain accompanied with dyspnea. His chest x-ray showed massive right-sided pleural effusion. The pleural fluid amylase was markedly elevated (8840 U/L), higher than that in the serum (3318 U/L). Abdominal CT scan showed a cystic structure measuring about 5·2 cm in the head of pancreas, highly suggestive of a pancreatic pseudocyst. Pleural effusion resolved after 3 weeks of chest tube insertion but not completely. After this period of conservative therapy another CT scan showed that pseudocyst was still in the head of pancreas. So, external drainage was done with mushroom insertion and the patient was discharged after 40 days of hospitalization. The cause of pancreatitis could not be identified.ConclusionPancreatitis should be taken into consideration when hemorrhagic pleural effusion, especially in the right hemithorax occurs.

Highlights

Hemorrhagic pleural effusion, especially in the right hemithorax rarely occurs as the sole presentation of pancreatitis.Case Presentation: This article reports massive right-sided hemorrhagic pleural effusion as the sole manifestation of pancreatitis in a 16-year-old Iranian boy
Pancreatitis should be taken into consideration when hemorrhagic pleural effusion, especially in the right hemithorax occurs
Most cases of hemorrhagic pleural effusion secondary to pancreatitis are between the ages of 20 to 55, and patients are alcohol drinkers [2,5]

Summary

Background

Hemorrhagic pleural effusion, especially in the right hemithorax, rarely occurs as the sole manifestation of pancreatitis [1,2,3,4,5,6]. This article reports massive right-sided hemorrhagic pleural effusion as the sole manifestation of pancreatitis in a 16-year-old Iranian boy. This 16-year-old boy, from a village in Fars Province, Southern Iran, developed left paraumblical (sometimes epigastric)abdominal pain with moderate intensity about five months prior to admission. Due to markedly elevated serum and pleural fluid amylase abdominal CT scan was done 2 days after insertion of chest tube at the 8th day of hospitalization. Drain output was about 1500 cc at the first day of chest tube insertion but it decreased gradually After this period of conservative therapy another abdominal CT scan showed a mass measuring 3·4 cm in the head of pancreas with possibility of pseudocyst.

Discussion

Conclusion

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