Abstract
This paper presents a rare case of pancreatic cyst with amylase rich left hemothorax which occured subsequently to right hydropneumothorax. After 6 months hospitalization, a 53-year-old male with right hydropneumothorax, probably due to repeated thoracentesis for intractable pleural effusion, was referred to the first Department of Surgery, Teikyo University Hospital. Closed tube drainage was carried out for one week, however lung re-expansion did not seem probable because of thickened pleural peel. In this particular case, therefore, decortication was performed. The postoperative course was uneventful and he was discharged one and a half months after surgery. However, he was hospitalized again about 3.5 months after the initial surgery due to dyspnea. Chest X-ray films and thoracentesis revealed left hemothorax. A pancreaticopleural fistula was strongly suspected because pleural hemorrhagic effusion contained high amylase in comparison to serum amylase level. With repeated cytological studies of pleural effusion, hypotonic duodenography, ERCP, selective angiography and CT scan, the diagnosis of pancreatiocopleural fistula due to carcinoma or cyst of the pancreas was made and the patient consented to undergo a second surgical procedure. No malignant lesion was noted macroscopically. Moreover, a definite sinus tract between pancreas and pleural cavity was obscured, but several-cord like substances were noted between the two. A resection of the tail of the pancreas including the cyst and cord like substances associated with tube drainage for left hemothorax was carried out in the second surgical procedure. The hemothorax findindings rapidly disappeared after surgery and the patient is now leading normal life. Unfortunately, the amylase level of the right thoracic effusion which was seen on the occasion of the first hospitalization was not analyzed, however, it might also be attributable to the pancreaticopleural fistula, from the aspects of clinical course, thoracotomy findings and review of the literature.
