Tuberc Respir Dis.  2014 May;76(5):240-244. 10.4046/trd.2014.76.5.240.

Pancreaticothoracic Fistula Presenting with Hemoptysis and Pneumothorax in a Chronic Alcoholic Patient

• Lee SN
• Lee KH
• Chung S
• Nam HS
• Cho JH
• Ryu JS
• Kwak SM

• KMID: 1842971
• DOI: http://doi.org/10.4046/trd.2014.76.5.240

Abstract

Pancreaticothoracic fistula is a rare complication of acute or chronic alcoholic pancreatitis. It may present with various symptoms, like dyspnea, abdominal pain, cough, chest pain, fever, back pain, hemoptysis, fatigue, or orthopnea. Pancreaticothoracic fistula can be detected by magnetic resonance cholangiopancreatography (MRCP), endoscopic retrograde cholangiopancreatography (ERCP), or computed tomography. MRCP has high sensitivity and fewer side effects, and thus it has recently been recommended as the first choice for the detection of pancreaticothoracic fistula. On the other hand, ERCP enables the detection and treatment of pancreaticothoracic fistula and allows for stent insertion; for this reason it is a commonly used modality in pancreaticothoracic fistula cases. Herein, the authors describe a case of pancreaticothoracic fistula detected by ERCP and MRCP that manifested only respiratory symptoms, namely hemoptysis and pneumothorax without abdominal pain, which commonly accompanies pancreatitis.

Keyword

Pancreatic Fistula; Hemoptysis; Pneumothorax; Cholangiopancreatography, Endoscopic Retrograde; Cholangiopancreatography, Magnetic Resonance

MeSH Terms

Abdominal Pain
Alcoholics*
Back Pain
Chest Pain
Cholangiopancreatography, Endoscopic Retrograde
Cholangiopancreatography, Magnetic Resonance
Cough
Dyspnea
Fatigue
Fever
Fistula*
Hand
Hemoptysis*
Humans
Pancreatic Fistula
Pancreatitis
Pancreatitis, Alcoholic
Pneumothorax*
Stents

Figure

• 

  Figure 1 Chest computed tomography in 1st admission showing patchy ground glass opacity and consolidation in the right middle and right lower lobes caused by hemorrhage or aspirated blood, and multiple air bubbles in mediastinum suggesting esophageal perforation (arrow).

• 

  Figure 2 Chest computed tomography image in 2nd admission showing right pneumothorax (arrow) and subcutaneous emphysema in the right chest and abdominal wall (short-tailed arrows).

• 

  Figure 3 (A) Chest computed tomography image showing 2.0×1.4-cm-sized air containing cavitary lesion superior aspect of pancreatic body in peripancreatic space extending to mediastinal inflammation (arrow). (B) Main pancreatic duct disruption and dye-leakage had been discovered in endoscopic retrograde cholangiopancreatography done on the 15th day of second admission (arrow).

• 

  Figure 4 (A) Magnetic resonance cholangiopancreatography image showing a 2.3-cm-sized cavitary cystic lesion and pancreaticothoracic fistula, suggestive of pancreatic pseudocyst rupture (arrow). (B) Endoscopic retrograde cholangiopancreatography image showing resolution of the main pancreatic duct partial disruption, and a main pancreatic duct stricture, benign (arrow).

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