Abstract
A 40 year-old potatory man was admitted to the Osaka City University Hospital on March, 31, 1977 complainixng of dyspnea and cough. His present illness began 11 months before admission, when he noticed dyspnea, ascites and edema. He was treated in the other hospital as pancreatic pleural effusion and pancreatic ascites. Chest X-ray examination revealed a great amounnt of effusion in the right pleural cavity. Thoracentesis yielded 1200 ml of serous effusion with an amylase value of 184500 international unit/1 with a protein value of 3.6 g/dl, whereas the serum amylase was 790 international unit/1. An upper gastrointestinal barium study including hypotonic duodenography was normal. Seventy days after admission the patient underwent an endoscopic retrograde cholangio-pancreatography. It revealed a main pancreatic duct and branches with a stenosis in the midpancreas with a dilatation and tortuousness of the duct. An additional finding was found that it communicated by way of a sinus tract through the aortic hiatus into the pleural space.
