Abstract:

Pancreatic-derived pleural effusion is commonly caused by pancreatic pseudocysts， pancreaticopleural fistula （PPF）， and pancreatitis. Its clinical presentation is primarily characterized by thoracic symptoms， with abdominal symptoms being less common and lacking specificity， leading to frequent diagnostic and therapeutic delays. Bilateral pleural effusions presenting as yellowish-brown turbid fluid with rapid alternating progression are rare， and no related cases were reported domestically or internationally. This article reported a case of patient with pancreatic-derived pleural effusion， summarized its clinical presentation， pleural pathological features， and management strategy， and the relevant literatures were reviewed. The patient， a 40-year-old male， presented with “cough， sputum production， chest pain accompanied by paroxysmal dyspnea”. His pleural effusion exhibited rapid progression with a yellowish-brown turbid appearance. After ruling out common causes， a definitive diagnosis remained elusive. During treatment， the patient developed sudden abdominal pain. Given his history of chronic alcohol consumption and prior gastrostomy for pancreatic pseudocyst， amylase testing of the pleural effusion was performed. This confirmed a diagnosis of pancreatic-derived pleural effusion secondary to pancreatic pseudocyst. The patient subsequently underwent endoscopic retrograde cholangiopancreatography （ERCP） and related interventional procedures. Regular follow-up revealed no recurrence of pleural effusion. For the patients with pleural effusion and a history of pancreatic disease， pancreatic origin should be considered regardless of abdominal symptoms， while vigilance is warranted for severe complications including hemothorax， empyema， mediastinitis， and respiratory failure. When medical management proves inadequate， meticulous evaluation of pancreatic drainage pathways and anatomical anomalies is essential to guide precise and individualized treatment and improve the patient’s prognosis.

Key words: Pleural effusion, Pancreatic pseudocyst, Thoracoscopy, Pancreatopleural fistula, Case report