Massive pleural effusion as the first symptom in chronic pancreatitis: A case report and literature review

Objective: To study the characteristics,diagnosis and differential diagnosis and treatment of chronic pancreatitis with massive pleural effusion first presented and frequently occurred but without clinical evidence of pancreatitis. Methods: A case of chronic pancreatitis with massive pleural effusion as the first clinical symptom was described.Diagnosis and differential diagnosis,laboratory test and radiographic patterns of the case were analyzed,and a literature review was performed. Results: A patient who was a long-term habitual drinker suddenly experienced severe right back and shoulder pain,and dyspnea.X-ray showed massive pleural effusion,which is usually recurrent and typically characterized by a very high concentration of amylase.Abdominal computed tomography scan showed calcification in the head of pancreas,dilatation of main pancreatic ducts and atrophy of pancreatic parenchyma adjacent to the pancreatic duct.The patient was conservatively treated.In the following 20 days,the patient received anti-secretory octreotide therapy,total parenteral nutrition and repeated thoracentesis or thoracic drainage.His pleural effusion was gradually resolved.The patient was discharged on day 35 with no recurrence of pleural effusion during theone month follow-up. Conclusion: Initial symptomatic massive pleural effusion and progressive elevated amylase in chronic pancreatitis patients are very rare,but they are the important indicators for the diagnosis of progressive elevated amylase in pleural effusion and abdominal radiography.Conservative treatment is necessary for most patients,and endoscopic retrograde cholangiopancreatography（ERCP） or surgery should be performed for others when conservative treatment fails.