From pulmonary thromboembolism to pancreatic pseudocyst fistulated in left pleura

Case presentation: A 66-year-old patient, chronically ethanol consumer, was hospitalized through emergency department with severe dyspnea due to bilateral massive pulmonary thromboembolism. Concomitantly the patient was diagnosed with a right kidney tumor of about 2 cm. After 7 days a second thoraco-abdominal-pelvic CT revealed a massive left pleural effusion, a voluminous pancreatic pseudo-cyst (40x59x85mm), and the disappearance of thrombi from the pulmonary arteries; in addition was reconfirmed the right kidney tumor in the absence of local extensions, lymph nodes or metastases. The patient presented several episodes of major abdominal pain, not evaluated, more than 6 months ago. Cardiac assessment revealed moderate systolic dysfunction in the absence of structural cardiac damage. Thoracocentesis showed that the pleural fluid is a transuded, with elevated levels of amylase and lipase. The amylase and lipase was also elevated in the blood, in the absence of abdominal pain. CT examination also revealed a milimetric fistula in the left hemi-diaphragm between the pancreatic pseudo-cyst and the left pleura. The patient was referred to the thoracic surgery unit for tract closure. After 3 repeated thoracocen-tesis, the pleural effusion was evacuated; it did not re-cover. In addition, the left ventricular systolic function improved. Subsequently the patient was hospitalized in oncology surgery for right kidney tumor excision.
Conclusions: T his clinical case presents a rare etio-logy of massive pleurisy secondary to a fistula between a pancreatic pseudo-cyst and the left pleura, although the cause of this pleural effusion might have been neo-plastic or cardiac.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)
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