Abstract
A 27-year-old male was admitted with progressive exertional dyspnea and right precordial tightening pain for about one month. The chest roentgenogram taken on admission disclosed a completely opacified right hemithorax. Multiple thoracenteses gave no information to make a definitive diagnosis. During hospitalization this patient complained of epigastric pain together with nausea, vomiting and pyrexia, accompanied by a remarkable rise of amylase in pleural effusion to 36, 600 units. Under a tentative diagnosis of pancreatic abscess exploratory laparotomy was performed. Operative pancreatography showed duct dilatation and irregular walls, pseudocyst and direct communications between the pancreatic pseudocyst and the right pleural cavity through fistulous tracts. In Japan this is the first case with internal pancreatic fistula into the right pleural cavity.
