J Gastrointestin Liver Dis, December 2018 Vol. 27 No 4: 465-469 1) Grigore T. Popa University of Medicine and Pharmacy Iași, 2) Gastroenterology and Hepatology Institute, Sf. Spiridon Emergency Hospital Iași, 3) III Medical Clinic, Sf. Spiridon Emergency Hospital Iași, 4) Regional Institute of Oncology, Iași, Romania Address for correspondence: Mariana Floria Sf. Spiridon Emergency Hospital Grigore T. Popa University of Medicine and Pharmacy 1 Independentei Street, 700111, Iasi, Romania foria_mariana@yahoo.com Received: 22.07.2018 Accepted: 27.10.2018 Pancreatico-Pleural Fistula – from Diagnosis to Management. A Case Report Catalina Mihai 1,2 , Mariana Floria 1,3 , Radu Vulpoi 1,2 , Loredana Nichita 1,2 , Cristina Cijevschi Prelipcean 1,2 , Vasile Drug 1,2 , Viorel Scripcariu 1,4 INTRODUCTION The first case of pleural effusion in pancreatitis was reported by Phillips (1901), followed by others until 1942, when Werner described the unusual nature of these efusions and the signifcance of pleural fuid amylase [1]. The pancreatic pseudocyst is a frequent complication of both acute and chronic pancreatitis. It is defined as a localized liquid collection with a non-epithelial wall (fibrous and granular tissue) containing high levels of pancreatic enzymes. A posterior rupture could cause a communication in the lef diaphragm with the formation of a fstula and pleural effusion. Patient’s symptoms may range from asymptomatic to progressively installed severe dyspnea, requiring thoracocentesis. Pancreatico- pleural fistula is an extremely ABSTRACT Pancreatic pseudocysts are frequent complications of both acute and chronic pancreatitis. By contrast, pancreatico-pleural fstula is rare. Here we report a case of massive pleural efusion secondary to a fstula in the lef hemi-diaphragm, between a pancreatic pseudocyst and the lef pleura, in a patient with a right kidney tumor and bilateral massive pulmonary thromboembolism. Tis fstula developed afer several episodes of un-investigated acute pancreatitis. Te pleural efusion was treated by three thoracocenteses, without recurrence. Key words: pancreatico-pleural fstula – pancreatic pseudocyst – pleural efusion. Abreviations: CT: computer tomography; TTE: transthoracic echocardiography. DOI: http://dx.doi.org/10.15403/jgld.2014.1121.274.ple rare complication of acute or chronic pancreatitis, usually being treated by surgery [2]. Te simultaneous fnding of a pancreatic pseudocyst, a massive lef pleural efusion, bilateral massive pulmonary thromboembolism and a malignant tumor could complicate the diagnosis route, making it necessary to accurately determine the etiology of the pleural efusion: neoplastic or pancreatic. CASE REPORT A 66-year-old male patient was hospitalized in the Emergency Department with transient severe dyspnea. Te patient had presented several episodes of major abdominal pain 6 months before, for which he did not seek medical attention. Upon admission, the patient had a mildly infuenced general condition, sinus tachycardia, without hemodynamic instability. He was underweight with a body mass index of 17.6 kg/m 2 . No abnormal pulmonary sounds on auscultation were detected. Blood tests were within normal range. Toracic computed tomography (CT) showed bilateral pulmonary thromboembolism (Fig. 1). Te electrocardiogram showed sinus tachycardia; transthoracic echocardiography (TTE) was without signifcant structural or functional changes. Te patient’s evolution was uneventful under anticoagulation therapy with unfractioned heparin during the frst week. Afer a transient aggravation of dyspneea, repeated TTE showed no signifcant new cardiac structural abnormality, with a good CASE REPORT