Recurrent Hemorrhagic Pleural Effusion Associated with Relapsing Pancreatitis

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

“…Right-sided hemorrhagic pleural effusion as the sole manifestation of pancreatitis is rare [1-4,6,7] especially when it occurs in the non-alcoholic patient under the age of 20 [2,3]. The postulated pathogenic mechanisms for hemorrhagic effusions include transdiaphragmatic transfer of fluid via lymphatics, diaphragmatic perforation of pseudocyst and mediastinal extension [1].…”

“…Considerable diagnostic problems may be encountered in cases in which the clinical picture is dominated by the pleuro-pulmonary symptoms, and the pancreatic condition remains completely or partly in the background [12]. An early and rapid diagnosis can be made by the examination of the pleural fluid for elevated amylase [2]. Visual methods such as computed tomography, ultrasonography, endoscopic retrograde cholongiopancreaticography (ERCP) are also useful [5].…”

“…Most cases of hemorrhagic pleural effusion secondary to pancreatitis are between the ages of 20 to 55, and patients are alcohol drinkers [2,5]. This article reports massive right-sided hemorrhagic pleural effusion as the sole manifestation of pancreatitis in a 16-year-old Iranian boy.…”

Hemorrhagic pleural effusion due to pseudo-pancreatic cyst

“…[ 1 2 3 4 5 6 ] Most cases of hemorrhagic pleural effusion secondary to pancreatitis occur between the ages of 20 and 55, along with a risk factor of alcohol intake. [ 4 5 ] The postulated pathogenic mechanisms for hemorrhagic effusions include trans-diaphragmatic transfer of fluid via lymphatics, diaphragmatic perforation of the pseudocyst and mediastinal extension. [ 1 ] Several studies demonstrated that a fistula connecting a pancreatic pseudocyst with pleural cavity was the plausible mechanism of pleural effusion.…”

Pleural Effusions Due to Diseases Below the Diaphragm

“…12 Neoplasm does not usually cause elevation to as high a level as pancreatic causes. In considering neoplastic causes, it should be remembered that chronic pancreatic pleural effusions may be hemorrhagic 13 and have been reported to be associated with a false-positive cytology result. 14 The diagnosis of chronic pancreatic pleural effusion due to a pancreatic-pleural fistula is suggested by an amylase-rich exudate that rapidly reaccumulates after thoracentesis in a patient with respiratory symptoms only.…”