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Pancreatic-Thoracic Fistula. An Unusual Complication of Pancreatitis
Fístula pancreato-torácica, una inusual complicación de la pancreatitis
Nuria Alonso Ordás
, Helena Gómez Herrero, Lesly Ortega Molina
Corresponding author
Servicio de Radiología, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
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An Unusual Complication of Pancreatitis" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "344" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Nuria Alonso Ordás, Helena Gómez Herrero, Lesly Ortega Molina" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Nuria" "apellidos" => "Alonso Ordás" "email" => array:1 [ 0 => "oroel10@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Helena" "apellidos" => "Gómez Herrero" ] 2 => array:2 [ "nombre" => "Lesly" "apellidos" => "Ortega Molina" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Radiología, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Fístula pancreato-torácica, una inusual complicación de la pancreatitis" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 600 "Ancho" => 1447 "Tamanyo" => 146922 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A and B) Coronal reconstructions of CT in a 47-year-old patient with a history of chronic pancreatitis complicated by a thoracopancreatic fistula. CT shows a loculated pleural effusion (star in B) connecting (arrow in A) with the pseudocyst (star in A), which in turn connects with the pancreatic duct (arrow in B). (C) Follow-up CT performed at 12 days, after ERCP and prosthesis placement (arrow in C), draining the pseudocyst and pleural collection via the pancreatic duct to the duodenum.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 47-year-old man with a history of chronic pancreatitis and pancreatic pseudocyst was admitted for asthenia, anorexia, and weight loss, vomiting, fever, and pleuritic chest pain. Computed tomography (CT) revealed bilateral loculated pleural effusion, with a transdiaphragmatic fistula connection between the pseudocyst and the pancreatic duct, and right paramediastinal collection (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">The patient developed progressive respiratory failure and was transferred to the ICU.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Given the findings, bilateral pleural drainage tubes were placed, and fluid with acute inflammatory cytology and elevated amylase was obtained. A pancreatic prosthesis was placed using endoscopic retrograde cholangiopancreatography (ERCP) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><p id="par0020" class="elsevierStylePara elsevierViewall">The patient's clinical and radiological status improved after these procedures.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Thoracic complications of pancreatitis are infrequent (15%–50%). The most common is pneumonia with pleural effusion. Pseudocyst extending to the mediastinum, thoracopancreatic fistula and mediastinitis are rarer.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Pleuropancreatic fistula (0.4%) is an abnormal connection between the pancreatic duct and the pleura. It is most commonly seen as a result of chronic alcoholic pancreatitis, and should be suspected in the case of persistent abundant pleural effusion (particularly in the left side) with elevated amylase. The fistula can be detected by CT, MRI or endoscopy.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Treatment includes control of the effusion, inhibition of pancreatic secretion, and isolation of the fistula by endoscopy or surgery.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Alonso Ordás N, Gómez Herrero H, Ortega Molina L. Fístula pancreato-torácica, una inusual complicación de la pancreatitis. Arch Bronconeumol. 2017;53:344.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 600 "Ancho" => 1447 "Tamanyo" => 146922 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A and B) Coronal reconstructions of CT in a 47-year-old patient with a history of chronic pancreatitis complicated by a thoracopancreatic fistula. CT shows a loculated pleural effusion (star in B) connecting (arrow in A) with the pseudocyst (star in A), which in turn connects with the pancreatic duct (arrow in B). (C) Follow-up CT performed at 12 days, after ERCP and prosthesis placement (arrow in C), draining the pseudocyst and pleural collection via the pancreatic duct to the duodenum.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:2 [ 0 => array:3 [ "identificador" => "bib0015" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mediastinitis secundaria a una pancreatitis aguda" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R. Ayuso-Velasco" 1 => "S. García-Barajas" 2 => "M. García-Sáez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbres.2011.01.007" "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2011" "volumen" => "47" "paginaInicial" => "318" "paginaFinal" => "321" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21420221" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0020" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Thoracopancreatic fistula: clinical and imaging findings" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.S. Fulcher" 1 => "G.W. Capps" 2 => "M.A. Turner" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Comput Assist Tomogr" "fecha" => "1999" "volumen" => "23" "paginaInicial" => "181" "paginaFinal" => "187" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10096323" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005300000006/v2_201707150125/S1579212917301271/v2_201707150125/en/main.assets" "Apartado" => array:4 [ "identificador" => "21342" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Clinical Image" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005300000006/v2_201707150125/S1579212917301271/v2_201707150125/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212917301271?idApp=UINPBA00003Z" ]
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