Pleural effusions and pancreatico-pleural fistulae associated with asymptomatic pancreatic disease

Four patients are described in whom recurrent large pleural effusions developed secondary to asymptomatic pancreatic disease. The diagnosis was made by measuring the amylase content of the pleural fluid. Endoscopic retrograde cholangiopancreatography (ERCP) and computed tomography (CT) were useful in demonstrating pancreaticopleural fistulae. Two patients underwent laparotomy and distal pancreatectomy. One recovered spontaneously after ERCP appeared to relieve an obstruction of the pancreatic duct and the other recovered after a period of parenteral nutrition. We suggest that pleural fluid amylase content should be measured in any case of exudative pleural effusion of unknown aetiology.