Chronic pancreatitis with Bochdalek hernia causing right-sided pleural effusion in a previously asymptomatic adult. (26th May 2018)

• Record Type: Journal Article
• Authors: Yeung, Ho-Man; Kumala, Erica; Stanek, Steven; Deng, Xiaoying
• Is Part Of: BMJ case reports. Volume 2018
• Publication Date: 2018-05-26
• Subjects: GI-stents -- pancreas and biliary tract -- pancreatitis; Medicine -- Case studies -- Periodicals; 610.5
• DOI: 10.1136/bcr-2018-224674
• Languages: English
• ISSNs: 1757-790X

Abstract

Abstract : A 41-year-old man with a medical history of chronic back pain, seizure disorder, alcohol and tobacco abuse presented with acute shortness of breath. Chest X-ray showed a large right-sided pleural effusion. Pleural fluid analysis was significant for an elevated amylase level, suggestive of pleural effusion secondary to pancreatitis. Magnetic resonance cholangiopancreatography (MRCP) revealed a persistent right-sided pleural effusion in connection with a right pararenal space fluid collection via a Bochdalek hernia. An endoscopic ultrasound found hyperechoic strands and foci, and pancreatic parenchyma consistent with chronic pancreatitis, as well as a pseudocyst in the pancreatic head. A chest tube was ultimately placed to continuously drain the pleural effusion. The patient was discharged and was referred to gastroenterology for outpatient follow-up. This case illustrates a rare presentation of chronic pancreatitis with a Bochdalek hernia as a right-sided pleural effusion in a patient who was previously asymptomatic.