ISSN: 2451-0637
Archives of Medical Science - Civilization Diseases
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1/2016
vol. 1
 
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abstract:
Letter to the Editor

Pediatric pancreaticopleural fistula: magnetic resonance imaging findings

Sinem Aydın
,
Rasul Sharifov
,
Serpil Kurtcan
,
Gizem Timocin
,
Alpay Alkan

Arch Med Sci Civil Dis 2016; 1: e70–e72
Online publish date: 2016/08/29
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Pancreaticopleural fistula (PPF) is a rare but severe complication of chronic pancreatitis [1, 2]. Patients diagnosed with PPF are commonly middle-aged (40–50 years) male patients (83%), with chronic pancreatitis related mainly to alcohol abuse (67%) [3]. It is very rare in the pediatric population due to lower incidence of chronic pancreatitis compared with adults. A pancreatic pleural effusion develops due to direct passage of pancreatic exudate through a natural hiatus in the diaphragm or by direct penetration through the dome of the diaphragm from a neighboring subdiaphragmatic collection [3]. Diagnosis can be late because of dominance of thoracic signs and symptoms. We review here key points in non-invasive diagnosis of a pancreaticopleural fistula with emphasis on magnetic resonance imaging (MRI) findings.
A 14-year-old girl presented with left sided chest pain and fever ongoing for a few days. She had a history of hospitalization due to pleural effusion. She had been also admitted to emergency room (ER) for recurrent abdominal pain. She had abdominal pain every day. At physical examination she had a fever about 38.5°C. Laboratory tests were normal. She had normal white blood cell count (WBC) level and C-reactive protein (CRP). Chest X-ray revealed a homogeneous opacity in left lower zone with pleural effusion (Figure 1 A). Effusion sample was hemorrhagic. Considering the pediatric age of the patient, hemorrhagic effusion was unexpected and a thoracic computed tomography (CT) was performed for a specific diagnosis. Computed tomography scan revealed a left lower lobe consolidation accompanied by air cysts (Figure 1 B). Pancreatic parenchyma contained calcifications in upper abdominal CT sections (Figure 2). An upper abdominal MRI was performed to clarify the etiology of pancreatic calcifications and extent of the pleural tubular structures within the peritoneal cavity. On MR images pancreatic parenchyma was diffusely atrophic. The pancreatic duct was diffusely dilated (Figure 3 A). In the pancreatic head a tubular structure in communication with the pancreatic duct extending superiorly to the left pleural space was seen (Figures 3 B, C). T2-weighted MR images well depicted the fistulous connection between the pancreatic duct and the pleural space. The patient was diagnosed with pancreaticopleural fistula and chronic pancreatitis. A 7 Fr stent was inserted into the main pancreatic duct endoscopically so that drainage was obtained. The...


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