2013-04-23 13:58:08 UTC

May 2013 <em>CGH</em> Image of the Month

April 25, 2013

This month's Clinical Gastroenterology and Hepatology image highlights the case of pleural effusion and pseudocyst in a 48-year-old man.

Pleural Effusion and Pseudocyst

A 48-year-old man presented with shortness of breath for two weeks. He denied any cough, hemoptysis, fever, chills, weight loss or abdominal pain. The patient was a heavy drinker for more than 40 years and had acute pancreatitis twice in the past four months. Physical examination revealed tachycardia and fever. Decreased breath sounds on both lung bases and dullness to percussion on the right side was appreciated. Abdominal examination was unremarkable. Pertinent laboratory findings included a white cell count of 12.0 K/μL with 11 percent bands. Liver functions were normal. A chest radiograph showed a right-sided pleural effusion (Figure A). Diagnostic thoracentesis revealed an exudative pleural effusion with negative cytology and cultures. Abdominal CT during this admission (Figure B) was compared with the CT performed two months previously (Figure C). Based on the clinical scenario and the CT findings, a diagnosis of rupture of the pseudocyst into the pleural cavity was made. Figure C shows pseudocysts marked by arrows, with pancreatic necrosis that developed as a complication of recent acute pancreatitis. Figure B from the current admission at the same level does not reveal the same pseudocyst because it ruptured into the pleural cavity. No ascites or fistula between the abdominal and thoracic cavities were identified on the CT scan. Pleural fluid analysis was exudative with an amylase level of 37,000 IU/L, consistent with fluid of pancreatic origin. A barium swallow study ruled out esophageal perforation.

Read more in Clinical Gastroenterology and Hepatology.

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