Cases reported "Pleural Diseases"

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1/6. Thoracic manifestations of internal pancreatic fistulas: report of five cases.

    Thoracic manifestations of internal pancreatic fistulas are rare. During the last 8 yr, we have treated one patient with a mediastinal pseudocyst, three patients with pancreaticopleural fistulas, and one patient with a pancreaticobronchial fistula. Recurrent pleural effusions represent one of the main clinical features in this entity, and can often lead to false diagnoses. Determination of pancreatic enzyme activity, as well as the combination of ultrasonography, computerized tomography, and endoscopic retrograde cholangiopancreatography (ERCP), enable the establishment of the diagnosis. A complete pancreatic evaluation is the rationale for an adequate and efficient therapy which should always aim at a focal assentation.
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keywords = pancreatic fistula
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2/6. Internal pancreatic fistula to the pericardium and pleura.

    A report of a 38-year-old man with a 10 month course of illness characterized by recurrent pericardial and pleural high-protein, high-amylase effusions is presented. Operative pancreatogram demonstrated fistulization from the mid-pancreas through the mediastinum into both pleural spaces and the pericardium. Surgical detachment of the fistula and Roux-en-Y decompression of the pancreatic duct resulted in cure of the condition.
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keywords = pancreatic fistula
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3/6. Pancreatic pleural effusion with endoscopic retrograde cholangiopancreatography: A case report.

    A case is discussed of a 30-year-old Black woman who developed a massive pseudocyst of the pancreas while under investigation in hospital for a left pleural effusion. An internal pancreatic fistula to the pleural space was demonstrated at endoscopic retrograde cholangiopancreatography. The patient recovered completely after distal pancreatectomy with splenectomy.
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ranking = 0.2
keywords = pancreatic fistula
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4/6. Chronic massive pancreatic pleural effusion.

    Chronic massive pancreatic pleural effusion is an uncommon and often unrecognized clinical syndrome which results from an internal pancreatic fistula and usually presents as an exudative effusion of unknown cause. The effusion frequently occurs without clinical evidence of pancreatitis, but occasionally it may be associated with a pseudocyst of the pancreas. Chronic massive pancreatic pleural effusion is usually recurrent and characterized by very high levels of amylase in the pleural fluid. morbidity and mortality are reduced when a definite diagnosis is established and appropriate therapy rendered. In this report, three cases of chronic massive pancreatic pleural effusions are presented. Two of the three had no demonstrable pancreatic disease, and the condition responded to conservative therapy. The third patient had a pancreatic pseudocyst and an internal pancreatic fistula which was corrected only after multiple surgical procedures.
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keywords = pancreatic fistula
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5/6. Pleuropancreatic fistula: endoscopic retrograde cholangiopancreatography and computed tomography.

    The complementary use of endoscopic retrograde cholangiopancreatography and computed tomography in the diagnosis and management of pleuropancreatic fistulas is described in relation to four cases in which computed tomography revealed the thoracic extension of a pancreatic fistula not demonstrable by endoscopic retrograde cholangiopancreatography, although the latter indicated an abnormal pancreatic duct. The complementary use of both techniques may be necessary to define the pathologic anatomy so that the appropriate therapy, particularly the surgical approach, can be decided.
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ranking = 1.2
keywords = pancreatic fistula
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6/6. Endoscopic stent placement for internal and external pancreatic fistulas.

    stents have been effectively used for various pancreatic conditions. Pancreatic fistulas, however, have traditionally been considered a surgical disease, and if the fistula does not respond to conservative measures, an operation is usually performed. stents were placed endoscopically in five consecutive patients who presented with pancreatic fistulas that did not respond to conservative management. Fistulas resolved in all patients after endoscopic stent placement, and after 14-30 months of follow-up, none has recurred. The cases comprise two patients with pancreaticocutaneous fistula and one each with pancreaticopleural, pancreaticoperitoneal, and pancreaticocholedochal fistula. The need for an operation can be obviated in many patients with internal and external pancreatic fistulas.
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ranking = 1
keywords = pancreatic fistula
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